Provider First Line Business Practice Location Address:
LIFESTANCE
Provider Second Line Business Practice Location Address:
5007 S HOWELL AVE SUITE 350
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53207-6159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-789-1191
Provider Business Practice Location Address Fax Number:
262-821-6180
Provider Enumeration Date:
03/19/2015