Provider First Line Business Practice Location Address:
1701 W KNAPP ST STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICE LAKE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54868-1350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-434-8364
Provider Business Practice Location Address Fax Number:
715-434-8367
Provider Enumeration Date:
07/21/2010