Provider First Line Business Practice Location Address:
9244 29TH AVE
Provider Second Line Business Practice Location Address:
ATTN: THERAPY DEPT
Provider Business Practice Location Address City Name:
KENOSHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53143-6602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-694-0080
Provider Business Practice Location Address Fax Number:
262-942-7395
Provider Enumeration Date:
03/25/2009