Provider First Line Business Practice Location Address:
823 N 2ND ST
Provider Second Line Business Practice Location Address:
SUITE 213
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53203-1818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-272-1466
Provider Business Practice Location Address Fax Number:
414-272-1467
Provider Enumeration Date:
08/25/2005