Provider First Line Business Practice Location Address:
950 N 12TH 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:
53201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-219-7745
Provider Business Practice Location Address Fax Number:
414-219-7753
Provider Enumeration Date:
08/07/2006