Provider First Line Business Practice Location Address:
3409 N DOWNER AVE
Provider Second Line Business Practice Location Address:
PAV 250, SPORTS MEDICINE
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-229-6572
Provider Business Practice Location Address Fax Number:
414-229-6671
Provider Enumeration Date:
11/17/2010