Provider First Line Business Practice Location Address:
12686 COUNTY HWY K
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANITOWISH WATERS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-543-8417
Provider Business Practice Location Address Fax Number:
715-543-8868
Provider Enumeration Date:
11/23/2007