Provider First Line Business Practice Location Address:
221 10TH AVENUE EAST
Provider Second Line Business Practice Location Address:
VOCATIONAL REHABILITATION BUILDING
Provider Business Practice Location Address City Name:
MENOMONIE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54751-2474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-232-1419
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/18/2008