Provider First Line Business Practice Location Address:
6930 WEST SCHOOL STREET
Provider Second Line Business Practice Location Address:
THREE LAKES SCHOOL
Provider Business Practice Location Address City Name:
THREE LAKES
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-369-7474
Provider Business Practice Location Address Fax Number:
715-369-7475
Provider Enumeration Date:
10/15/2008