Provider First Line Business Practice Location Address:
5700 W GREEN TREE RD
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:
53223-5220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-393-3900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/26/2026