Provider First Line Business Practice Location Address:
1215 W KNAPP ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICE LAKE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54868-1307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-236-4450
Provider Business Practice Location Address Fax Number:
715-236-1831
Provider Enumeration Date:
11/21/2014