Provider First Line Business Practice Location Address:
3380 S KINNICKINNIC 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:
53207-3159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-482-2090
Provider Business Practice Location Address Fax Number:
414-482-0265
Provider Enumeration Date:
04/09/2008