Provider First Line Business Practice Location Address:
1747 SHAWANO AVE
Provider Second Line Business Practice Location Address:
ADVANCED PHYSICAL THERAPY & SPORTS MEDICINE
Provider Business Practice Location Address City Name:
GREEN BAY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54303-3261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-497-3538
Provider Business Practice Location Address Fax Number:
920-965-1659
Provider Enumeration Date:
08/12/2005