Provider First Line Business Practice Location Address:
16 E MENARD PLAZA
Provider Second Line Business Practice Location Address:
SPORT & SPINE CLINIC
Provider Business Practice Location Address City Name:
WAUSAU
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-845-2942
Provider Business Practice Location Address Fax Number:
715-842-3416
Provider Enumeration Date:
05/15/2006