Provider First Line Business Practice Location Address:
3267 SOUTH 16TH STREET
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-672-8230
Provider Business Practice Location Address Fax Number:
414-672-0046
Provider Enumeration Date:
08/17/2005