Provider First Line Business Practice Location Address:
2600 S WISCONSIN AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICE LAKE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54868-7527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-855-0430
Provider Business Practice Location Address Fax Number:
715-236-3615
Provider Enumeration Date:
05/04/2006