Individual
MR. EDWARD RAY EASLEY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBE
Contact information
Practice address
8608 W HEMLOCK ST, MILWAUKEE, WI 53224-4042
(414) 788-1727
Mailing address
8608 W HEMLOCK ST, MILWAUKEE, WI 53224-4042
(414) 788-1727
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
E2402367714503
WI
Other
Enumeration date
08/24/2021
Last updated
08/24/2021
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