Provider First Line Business Practice Location Address:
7410 N TEUTONIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53209-2008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-351-6161
Provider Business Practice Location Address Fax Number:
414-351-6162
Provider Enumeration Date:
11/15/2006