Provider First Line Business Practice Location Address:
1615 BARTON AVENUE
Provider Second Line Business Practice Location Address:
NORTHSHORE CLINIC & CONSULTANTS INC
Provider Business Practice Location Address City Name:
WEST BEND
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-334-5323
Provider Business Practice Location Address Fax Number:
262-334-4475
Provider Enumeration Date:
02/01/2007