Provider First Line Business Practice Location Address:
3130 SHORE DR STE 111
Provider Second Line Business Practice Location Address:
BAY AREA NEUROLOGY CONSULTATNTS
Provider Business Practice Location Address City Name:
MARINETTE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54143-4291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-732-8212
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2005