Provider First Line Business Practice Location Address:
8989 N PORT WASHINGTON ROAD
Provider Second Line Business Practice Location Address:
SUITE 122
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-351-6250
Provider Business Practice Location Address Fax Number:
414-351-6465
Provider Enumeration Date:
07/09/2006