Provider First Line Business Practice Location Address:
2915 S KINNICKINNIC 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:
53207-2518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-712-4515
Provider Business Practice Location Address Fax Number:
414-751-5145
Provider Enumeration Date:
09/15/2008