Provider First Line Business Practice Location Address:
5131 N GREEN BAY AVE
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:
53209-5753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-247-7382
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2026