Provider First Line Business Practice Location Address:
VAMC, SURGICAL SERVICES, ROOM: C4684
Provider Second Line Business Practice Location Address:
4646 JOHN R
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201-1932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-576-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2006