Provider First Line Business Practice Location Address:
4353 S HOWELL AVE
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:
53207-5050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-483-3550
Provider Business Practice Location Address Fax Number:
414-483-2150
Provider Enumeration Date:
01/03/2006