Provider First Line Business Practice Location Address:
2573 NORTH 44TH STREET
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:
53210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-447-1238
Provider Business Practice Location Address Fax Number:
414-482-2441
Provider Enumeration Date:
02/22/2008