Provider First Line Business Practice Location Address:
2211 N HUMBOLDT BLVD
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:
53212-3507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-336-7200
Provider Business Practice Location Address Fax Number:
414-777-5210
Provider Enumeration Date:
11/16/2007