Provider First Line Business Practice Location Address:
3200 S 20TH ST
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:
53215-4442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-389-3274
Provider Business Practice Location Address Fax Number:
414-389-3300
Provider Enumeration Date:
06/24/2008