Provider First Line Business Practice Location Address:
1020 N 12TH STREET
Provider Second Line Business Practice Location Address:
5TH FLOOR
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-277-8990
Provider Business Practice Location Address Fax Number:
414-277-8969
Provider Enumeration Date:
10/25/2006