Provider First Line Business Practice Location Address:
205 W MENOMONIE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELK MOUND
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54739-9520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-879-4480
Provider Business Practice Location Address Fax Number:
715-879-4490
Provider Enumeration Date:
08/20/2009