Provider First Line Business Practice Location Address:
5324 S 27TH ST
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:
53221-3724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-281-7198
Provider Business Practice Location Address Fax Number:
414-281-3059
Provider Enumeration Date:
11/01/2006