Provider First Line Business Practice Location Address: 
ZABLOCKI DEPARTMENT OF VETERAN AFFAIRS MEDICAL CTR
    Provider Second Line Business Practice Location Address: 
5000 WEST NATIONAL AVENUE
    Provider Business Practice Location Address City Name: 
MILWAUKEE
    Provider Business Practice Location Address State Name: 
WI
    Provider Business Practice Location Address Postal Code: 
53295-0001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
414-384-2000
    Provider Business Practice Location Address Fax Number: 
414-389-4276
    Provider Enumeration Date: 
07/24/2006