Provider First Line Business Practice Location Address:
1834 W WISCONSIN AVE
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:
53233-2125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-933-9813
Provider Business Practice Location Address Fax Number:
414-933-1522
Provider Enumeration Date:
04/25/2007