Provider First Line Business Practice Location Address:
2446 SOUTH 102ND STREET SUITE 340
Provider Second Line Business Practice Location Address:
MJ CARE
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-776-7016
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/20/2011