Provider First Line Business Practice Location Address:
5800 W WAHNER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWN DEER
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53223-2958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-239-4462
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2026