Provider First Line Business Practice Location Address:
8989 N PORT WASHINGTON RD
Provider Second Line Business Practice Location Address:
STE 220
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53217-4437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-352-3336
Provider Business Practice Location Address Fax Number:
414-352-3928
Provider Enumeration Date:
04/08/2006