Provider First Line Business Practice Location Address:
1801 WEST WISCONSIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-288-0788
Provider Business Practice Location Address Fax Number:
414-288-0678
Provider Enumeration Date:
10/05/2006