Provider First Line Business Practice Location Address:
1155 N MAYFAIR RD
Provider Second Line Business Practice Location Address:
SPINE CARE CLINIC
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53226-3462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-955-7199
Provider Business Practice Location Address Fax Number:
414-955-0110
Provider Enumeration Date:
09/18/2015