Provider First Line Business Practice Location Address:
3415 SHERIDAN ROAD
Provider Second Line Business Practice Location Address:
WOODSTOCK REHAB DEPT
Provider Business Practice Location Address City Name:
KENOSHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-657-6175
Provider Business Practice Location Address Fax Number:
262-657-6681
Provider Enumeration Date:
05/13/2008