Provider First Line Business Practice Location Address:
945 N 12TH STREET
Provider Second Line Business Practice Location Address:
AURORA HEALTH CARE #3858
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53201-0342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-279-0993
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2008