Provider First Line Business Practice Location Address:
1775 S. PRAIRIE VIEW RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHIPPEWA FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-828-4896
Provider Business Practice Location Address Fax Number:
715-833-8776
Provider Enumeration Date:
02/24/2026