Provider First Line Business Practice Location Address:
1141 N 46TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53208-2702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-344-1993
Provider Business Practice Location Address Fax Number:
414-344-5509
Provider Enumeration Date:
08/20/2007