Provider First Line Business Practice Location Address:
1801 W WISCONSIN AVE
Provider Second Line Business Practice Location Address:
MARQUETTE UNIVERSITY SCHOOL OF DENTISTRY. RM 325
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53233-2186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-288-6517
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2011