Provider First Line Business Practice Location Address:
5000 W NATIONAL AVE
Provider Second Line Business Practice Location Address:
RESEARCH DIVISION/151 VA MED CENTER/MED COLLEGE OF WI
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53295
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-384-2000
Provider Business Practice Location Address Fax Number:
414-382-5320
Provider Enumeration Date:
03/03/2015