Provider First Line Business Practice Location Address:
9000 W WISCONSIN AVE
Provider Second Line Business Practice Location Address:
CHILDREN'S HEALTH SYS OFFICE BLDG
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53226-3518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-266-2948
Provider Business Practice Location Address Fax Number:
414-266-3261
Provider Enumeration Date:
05/19/2006