Provider First Line Business Practice Location Address:
1225 W HISTORIC MITCHELL ST STE 223
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53204-3383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-383-4455
Provider Business Practice Location Address Fax Number:
414-383-6759
Provider Enumeration Date:
12/05/2006