Provider First Line Business Practice Location Address:
611 FRANKLIN ST
Provider Second Line Business Practice Location Address:
MOBILE CLINIC'S HOME BASE.
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53925-1434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-626-8881
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/27/2025