Provider First Line Business Practice Location Address:
235 W PRAIRIE VIEW RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
CHIPPEWA FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54729-3639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-720-9125
Provider Business Practice Location Address Fax Number:
715-720-1475
Provider Enumeration Date:
11/28/2006