Provider First Line Business Practice Location Address:
930 E KNAPP 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:
53202-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-221-0022
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2006