Provider First Line Business Practice Location Address:
4418 W CONGRESS 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:
53218-5261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-368-7657
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2021