Provider First Line Business Practice Location Address:
212 E GREEN BAY ST
Provider Second Line Business Practice Location Address:
ADVANCED PHYSICAL THERAPY & SPORTS MEDICINE OF SHAWANO
Provider Business Practice Location Address City Name:
SHAWANO
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54166-2472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-526-5221
Provider Business Practice Location Address Fax Number:
715-526-2542
Provider Enumeration Date:
08/12/2005