Provider First Line Business Practice Location Address:
1500 WOODLAND RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUSAU
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54403-2364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-301-3222
Provider Business Practice Location Address Fax Number:
715-430-3296
Provider Enumeration Date:
07/25/2026