Provider First Line Business Practice Location Address:
3829 SOUTH CHICAGO AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-762-3838
Provider Business Practice Location Address Fax Number:
414-571-4864
Provider Enumeration Date:
10/01/2007