Provider First Line Business Practice Location Address:
2801 COUNTY HWY I
Provider Second Line Business Practice Location Address:
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-720-9710
Provider Business Practice Location Address Fax Number:
715-720-1814
Provider Enumeration Date:
10/01/2007