Provider First Line Business Practice Location Address:
140 24TH ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WISCONSIN RAPIDS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54494-1906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-424-1881
Provider Business Practice Location Address Fax Number:
715-423-1602
Provider Enumeration Date:
06/17/2006