Provider First Line Business Practice Location Address:
5308 W. GREENFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-384-8554
Provider Business Practice Location Address Fax Number:
414-264-8119
Provider Enumeration Date:
11/17/2010