Provider First Line Business Practice Location Address:
932 LAKE AVE
Provider Second Line Business Practice Location Address:
LAKE HOUSE HEALTH & LEARNING CENTER
Provider Business Practice Location Address City Name:
RACINE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53403-1519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-633-2645
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2007