Provider First Line Business Practice Location Address:
2815 COUNTY HIGHWAY I
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CHIPPEWA FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54729-2656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-726-0834
Provider Business Practice Location Address Fax Number:
715-726-1067
Provider Enumeration Date:
10/10/2012