Provider First Line Business Practice Location Address:
2301 N LAKE DR RM 1577
Provider Second Line Business Practice Location Address:
COLUMBIA ST MARY'S MS CLINIC
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53211-4508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-291-1771
Provider Business Practice Location Address Fax Number:
414-291-1781
Provider Enumeration Date:
07/08/2008