Provider First Line Business Practice Location Address:
335 E. MONROE AVENUE
Provider Second Line Business Practice Location Address:
ROOM 112
Provider Business Practice Location Address City Name:
BARRON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54812-1478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-537-6225
Provider Business Practice Location Address Fax Number:
715-537-6851
Provider Enumeration Date:
10/23/2009