Provider First Line Business Practice Location Address:
111 W MICHIGAN ST
Provider Second Line Business Practice Location Address:
PROSTEP/EXTENDICARE HEALTH SERVICES
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-724-5270
Provider Business Practice Location Address Fax Number:
570-724-5276
Provider Enumeration Date:
10/31/2007