Provider First Line Business Practice Location Address:
3073 S. CHASE AVE
Provider Second Line Business Practice Location Address:
SUITE 326
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-881-8288
Provider Business Practice Location Address Fax Number:
414-289-1175
Provider Enumeration Date:
01/30/2009