Provider First Line Business Practice Location Address:
1228 E BRADY ST
Provider Second Line Business Practice Location Address:
1228 E. BRADY ST.
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53202-1654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-278-8513
Provider Business Practice Location Address Fax Number:
414-278-0726
Provider Enumeration Date:
11/29/2009