Provider First Line Business Practice Location Address:
21425 SPRING ST
Provider Second Line Business Practice Location Address:
PRIMARY CARE UNION GROVE
Provider Business Practice Location Address City Name:
UNION GROVE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53182-9707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-878-7001
Provider Business Practice Location Address Fax Number:
262-878-7024
Provider Enumeration Date:
07/26/2006