Provider First Line Business Practice Location Address:
1032 SOUTH 16TH ST.
Provider Second Line Business Practice Location Address:
STE. 219
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-672-3145
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2006