Provider First Line Business Practice Location Address:
1220 6TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUSAU
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54403-3550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-845-7759
Provider Business Practice Location Address Fax Number:
715-845-4509
Provider Enumeration Date:
12/21/2006