Provider First Line Business Practice Location Address:
3237 S 16TH STREET
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:
53215-4526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-647-5126
Provider Business Practice Location Address Fax Number:
414-647-7012
Provider Enumeration Date:
01/04/2006