Provider First Line Business Practice Location Address:
100 15TH AVE
Provider Second Line Business Practice Location Address:
LAKESHORE BUISNESS OFFICE, ATTN: GRETCHEN SCHWEISS
Provider Business Practice Location Address City Name:
SOUTH MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53172-1160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-744-6589
Provider Business Practice Location Address Fax Number:
414-747-8848
Provider Enumeration Date:
05/23/2013