Provider First Line Business Practice Location Address:
419 2ND STREET WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENOMONIE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-235-3590
Provider Business Practice Location Address Fax Number:
715-235-3661
Provider Enumeration Date:
03/12/2007