Provider First Line Business Practice Location Address:
3515 COOLIDGE RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48823-8014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-332-2422
Provider Business Practice Location Address Fax Number:
517-332-0810
Provider Enumeration Date:
08/26/2012