Provider First Line Business Practice Location Address:
2300 WESTERN AVE
Provider Second Line Business Practice Location Address:
LAKESHORE RADIOLOGY
Provider Business Practice Location Address City Name:
MANITOWOC
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-320-3800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2009