Provider First Line Business Practice Location Address:
1211 HUNTINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WISCONSIN RAPIDS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54494-7934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-423-5950
Provider Business Practice Location Address Fax Number:
715-423-0693
Provider Enumeration Date:
02/16/2010