Provider First Line Business Practice Location Address:
PAVILION 350; ATEP
Provider Second Line Business Practice Location Address:
UNIVERSITY OF WISCONSIN MILWAUKEE
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53201-0413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-229-3369
Provider Business Practice Location Address Fax Number:
414-229-3366
Provider Enumeration Date:
10/07/2008