Provider First Line Business Practice Location Address:
2820 S WISCONSIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICE LAKE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54868-8573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
745-234-8444
Provider Business Practice Location Address Fax Number:
715-234-0041
Provider Enumeration Date:
08/15/2005