Provider First Line Business Practice Location Address: 
1000 MINERAL POINT AVE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
JANESVILLE
    Provider Business Practice Location Address State Name: 
WI
    Provider Business Practice Location Address Postal Code: 
53548-2940
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
608-756-6000
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
03/05/2007