Provider First Line Business Practice Location Address:
2600 S WISCONSIN AVENUE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
RICE LAKE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54868-7527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-236-3610
Provider Business Practice Location Address Fax Number:
715-236-3615
Provider Enumeration Date:
03/25/2007