Provider First Line Business Practice Location Address:
2929 N OAKLAND AVE
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:
53211-3229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-332-3195
Provider Business Practice Location Address Fax Number:
414-332-6770
Provider Enumeration Date:
08/15/2005