Individual
THERESA RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9455 W WATERTOWN PLANK RD FL 4, WAUWATOSA, WI 53226-3559
(414) 257-6302
Mailing address
9455 W WATERTOWN PLANK RD FL 4, WAUWATOSA, WI 53226-3559
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
03/30/2020
Last updated
03/30/2020
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