Provider First Line Business Practice Location Address:
2025 W OKLAHOMA AVE
Provider Second Line Business Practice Location Address:
SUITE 114
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53215-4455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-647-1537
Provider Business Practice Location Address Fax Number:
414-647-1560
Provider Enumeration Date:
09/11/2006