Provider First Line Business Practice Location Address:
3001 US HIGHWAY 12 E
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
MENOMONIE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54751-5569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-232-1518
Provider Business Practice Location Address Fax Number:
715-232-1888
Provider Enumeration Date:
11/29/2005