Provider First Line Business Practice Location Address:
605 S 24TH AVE STE 20
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUSAU
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54401-1705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-345-2797
Provider Business Practice Location Address Fax Number:
715-345-7289
Provider Enumeration Date:
03/02/2026