Provider First Line Business Practice Location Address:
6887 S. LAKE AVE.
Provider Second Line Business Practice Location Address:
WAPITI MEDICAL GROUP
Provider Business Practice Location Address City Name:
LAKE NEBAGAMON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-270-8820
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2006