Provider First Line Business Practice Location Address:
1110 N OLD WORLD 3RD ST STE 410
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:
53203-1121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-272-0223
Provider Business Practice Location Address Fax Number:
414-273-8220
Provider Enumeration Date:
11/28/2006