Provider First Line Business Practice Location Address:
W165 N5595 CREEKWOOD CROSSING
Provider Second Line Business Practice Location Address:
KOHL'S WELLNESS CENTER
Provider Business Practice Location Address City Name:
MENOMONEE FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-252-1060
Provider Business Practice Location Address Fax Number:
262-252-4781
Provider Enumeration Date:
08/23/2006