Provider First Line Business Practice Location Address:
2311 N PROSPECT AVE STE 5A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53211-4445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-319-3000
Provider Business Practice Location Address Fax Number:
414-319-3097
Provider Enumeration Date:
01/23/2011