Provider First Line Business Practice Location Address:
3365 S 103RD ST
Provider Second Line Business Practice Location Address:
PEDIATRIC SPORTS MEDICINE
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53227-4161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-955-2600
Provider Business Practice Location Address Fax Number:
414-955-6440
Provider Enumeration Date:
05/14/2007