Provider First Line Business Practice Location Address:
312 W KNAPP ST STE B
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:
54868-1631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-836-0064
Provider Business Practice Location Address Fax Number:
715-836-0065
Provider Enumeration Date:
07/17/2023