Provider First Line Business Practice Location Address:
4117 N GREEN BAY AVE STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53209-7019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-232-4886
Provider Business Practice Location Address Fax Number:
414-433-5780
Provider Enumeration Date:
03/12/2026