Individual
MRS. ALICIA MARIE BRUDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
219 RIVER AVE S, PRAIRIE FARM, WI 54762-9786
(715) 455-1166
Mailing address
219 RIVER AVE S, P.O. BOX 65, PRAIRIE FARM, WI 54762-9786
(715) 455-1166
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
12453-146
WI
Other
Enumeration date
05/27/2014
Last updated
05/27/2014
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