Provider First Line Business Practice Location Address:
2100 N 29TH ST
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:
53208-1527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-344-1030
Provider Business Practice Location Address Fax Number:
414-342-7702
Provider Enumeration Date:
01/12/2007