Provider First Line Business Practice Location Address:
2509 COUNTY HIGHWAY I
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHIPPEWA FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-723-9138
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/24/2011