RUSSELL DONALD DE LAP

MEQUON, WI
NPI1104969336
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: WI  4039)
Enumeration Date2007-02-15
Last Update Date2007-07-08
Business Address
-- RUSSELL DONALD DE LAP ATC
12800 N LAKE SHORE DR
MEQUON, WI 53097-2418
Phone number: 262-243-4323
Mailing Address
-- RUSSELL DONALD DE LAP ATC
1165 TOWER HILL DR
BROOKFIELD, WI 53045-6705
Phone number: 262-789-5040
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