Provider First Line Business Practice Location Address:
2661 COUNTY ROAD I
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHIPPEWA FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-726-3447
Provider Business Practice Location Address Fax Number:
715-726-3649
Provider Enumeration Date:
10/29/2010