Provider First Line Business Practice Location Address:
600 EAST COUNTY HIGHWAY B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELL LAKE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54871-0356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-468-2125
Provider Business Practice Location Address Fax Number:
715-468-2167
Provider Enumeration Date:
04/11/2006