Provider First Line Business Practice Location Address:
1692 HWY 53 N
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:
715-830-8270
Provider Business Practice Location Address Fax Number:
715-830-8272
Provider Enumeration Date:
05/13/2008