Provider First Line Business Practice Location Address:
112 EAST FIFTH AVE
Provider Second Line Business Practice Location Address:
LANGLADE MEMORIAL HOSPITAL
Provider Business Practice Location Address City Name:
ANTIGO
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54409-2710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-539-8181
Provider Business Practice Location Address Fax Number:
715-539-2462
Provider Enumeration Date:
10/12/2006