Provider First Line Business Practice Location Address:
8701 W WATERTOWN PLANK ROAD
Provider Second Line Business Practice Location Address:
LAB BUILDING, ROOM 226
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53226-3548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-805-6975
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2026