Provider First Line Business Practice Location Address:
3935 WEST MITCHELL STREET
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:
53215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-382-7252
Provider Business Practice Location Address Fax Number:
414-643-0270
Provider Enumeration Date:
07/11/2006