Provider First Line Business Practice Location Address:
3821 W CHICAGO RD
Provider Second Line Business Practice Location Address:
WILLOWCREST CARE CENTER
Provider Business Practice Location Address City Name:
SOUTH MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53172-3712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-762-7336
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/25/2007