Provider First Line Business Practice Location Address:
520 N 28TH AVENUE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
WAUSAU
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-848-1346
Provider Business Practice Location Address Fax Number:
715-845-1244
Provider Enumeration Date:
07/07/2006