ProviderBusinessMailingAddressFaxNumber = '4405851962'
NPI
LastName
FirstName
MidName
Organization
Mailing Address
City
State
Zip
1912967209
LAKE HOSPITAL SYSTEM INC.
PO BOX 781348
DETROIT
MI
482781348
1699979781
DAREJEH
AFSANEH
29804 LAKE SHORE BLVD
WILLOWICK
OH
440954611
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