Provider First Line Business Practice Location Address:
2900 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:
53215-4330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-649-6942
Provider Business Practice Location Address Fax Number:
414-649-5091
Provider Enumeration Date:
12/28/2006