Provider First Line Business Practice Location Address:
3520 W OKLAHOMA AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-271-1166
Provider Business Practice Location Address Fax Number:
414-271-1167
Provider Enumeration Date:
10/05/2006