Provider First Line Business Practice Location Address:
13 E SPRUCE ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
CHIPPEWA FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54729-2579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-861-4422
Provider Business Practice Location Address Fax Number:
715-861-5141
Provider Enumeration Date:
01/02/2012