Provider First Line Business Practice Location Address:
930 E KNAPP ST STE 31
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:
53202-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-436-1340
Provider Business Practice Location Address Fax Number:
414-751-6981
Provider Enumeration Date:
04/01/2026