Provider First Line Business Practice Location Address:
6939 COUNTY HIGHWAY T
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHIPPEWA FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54729-5895
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-874-4429
Provider Business Practice Location Address Fax Number:
715-874-4469
Provider Enumeration Date:
10/05/2006