Provider First Line Business Practice Location Address:
LINCOLN AVENUE CLINIC
Provider Second Line Business Practice Location Address:
11211 WEST LINCOLN AVENUE
Provider Business Practice Location Address City Name:
WEST ALLIS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-456-5900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2006