Provider First Line Business Practice Location Address:
LAKESIDE PEDIATRICS
Provider Second Line Business Practice Location Address:
8600 75TH STREET
Provider Business Practice Location Address City Name:
KENOSHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-652-9430
Provider Business Practice Location Address Fax Number:
262-652-9433
Provider Enumeration Date:
05/20/2006