LYDIAWATI KURNIAWAN

VIROQUA, WI
NPI1487922316
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy225200000X Physical Therapy Assistant
(Licence: WI  1583-19)
Enumeration Date2011-12-07
Last Update Date2011-12-07
Business Address
Mrs. LYDIAWATI KURNIAWAN PTA
E7404A COUNTY ROAD BB
VIROQUA, WI 54665-7502
Phone number: 608-637-5422
Mailing Address
Mrs. LYDIAWATI KURNIAWAN PTA
821 TAHOE DR
ONALASKA, WI 54650-8234
Phone number: 608-779-9008
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