Provider First Line Business Practice Location Address:
2433 N HOLTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53212-2934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-264-6290
Provider Business Practice Location Address Fax Number:
414-264-6073
Provider Enumeration Date:
07/31/2009