Provider First Line Business Practice Location Address:
3615 W OKLAHOMA AVE
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:
53215-4119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-383-8787
Provider Business Practice Location Address Fax Number:
414-384-5123
Provider Enumeration Date:
03/13/2007