Provider First Line Business Practice Location Address:
NORTHLAKES COMMUNITY CLINIC
Provider Second Line Business Practice Location Address:
15954 RIVERS EDGE DRIVE
Provider Business Practice Location Address City Name:
HAYWARD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54843-5484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-634-2541
Provider Business Practice Location Address Fax Number:
715-934-5090
Provider Enumeration Date:
10/02/2009