Provider First Line Business Practice Location Address:
9200 W WISCONSIN AVE
Provider Second Line Business Practice Location Address:
OTOLARYNGOLOGY DEPT
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53226-3522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-805-5603
Provider Business Practice Location Address Fax Number:
414-476-4701
Provider Enumeration Date:
04/18/2008