Provider First Line Business Practice Location Address:
1801 W KNAPP ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
RICE LAKE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54868-1380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-234-1106
Provider Business Practice Location Address Fax Number:
715-736-0960
Provider Enumeration Date:
07/20/2006