Provider First Line Business Practice Location Address:
999 N 92ND STREET
Provider Second Line Business Practice Location Address:
CHILDRENS HOSPITAL OF WISCONSIN
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53201-1997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-266-2881
Provider Business Practice Location Address Fax Number:
414-337-7151
Provider Enumeration Date:
06/05/2008