Provider First Line Business Practice Location Address:
3115 N 5TH STREET
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:
53212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-914-9339
Provider Business Practice Location Address Fax Number:
414-914-9239
Provider Enumeration Date:
06/23/2023