Provider First Line Business Practice Location Address:
5535 COUNTY HWY Q
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WISCONSIN RAPIDS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-213-6379
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2006