Provider First Line Business Practice Location Address:
4113 N. PORT WASHINGTON RD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-434-4248
Provider Business Practice Location Address Fax Number:
414-431-8608
Provider Enumeration Date:
11/20/2015