Provider First Line Business Practice Location Address:
763 MILFORD ST
Provider Second Line Business Practice Location Address:
FRONTIER MENTAL HEALTH CLINIC
Provider Business Practice Location Address City Name:
WATERTOWN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53094-6021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-206-6115
Provider Business Practice Location Address Fax Number:
920-206-6106
Provider Enumeration Date:
08/05/2006