Provider First Line Business Practice Location Address:
12800 N LAKE SHORE DRIVE
Provider Second Line Business Practice Location Address:
STUDENT HEALTH CENTER ALBRECHT 113
Provider Business Practice Location Address City Name:
MEQUON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-243-4574
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2017