Provider First Line Business Practice Location Address:
802 E COUNTY HIGHWAY B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELL LAKE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54871-4425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-468-7292
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2010