Provider First Line Business Practice Location Address:
11340 W THEO TREKR WAY
Provider Second Line Business Practice Location Address:
FMC CENTRE POINT DIALYSIS
Provider Business Practice Location Address City Name:
WEST ALLIS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53214-1135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-774-1244
Provider Business Practice Location Address Fax Number:
414-774-8130
Provider Enumeration Date:
07/22/2010