Provider First Line Business Practice Location Address:
3034 N 25TH ST
Provider Second Line Business Practice Location Address:
HSE
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53206-1117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-442-1853
Provider Business Practice Location Address Fax Number:
414-442-8069
Provider Enumeration Date:
03/06/2007