Provider First Line Business Practice Location Address:
3906 S 27TH ST
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:
53221-1826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-281-3444
Provider Business Practice Location Address Fax Number:
414-281-3435
Provider Enumeration Date:
09/13/2010