Provider First Line Business Practice Location Address: 
1821 S STOUGHTON RD
    Provider Second Line Business Practice Location Address: 
DEAN MEDICAL CENTER
    Provider Business Practice Location Address City Name: 
MADISON
    Provider Business Practice Location Address State Name: 
WI
    Provider Business Practice Location Address Postal Code: 
53716-2257
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
608-260-6000
    Provider Business Practice Location Address Fax Number: 
608-260-6939
    Provider Enumeration Date: 
05/12/2006