Provider First Line Business Practice Location Address:
16001 W. NINE MILER ROAD
Provider Second Line Business Practice Location Address:
PROVIDENCE-PROVIDENCE PARK HOSPITALS - SOUTHFIELD
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-849-5664
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2016