Provider First Line Business Practice Location Address: 
UNIVERSITY OF WISCONSIN HOSPITAL AND CLINICS
    Provider Second Line Business Practice Location Address: 
600 HIGHLAND AVENUE, MAIL STOP 2424
    Provider Business Practice Location Address City Name: 
MADISON
    Provider Business Practice Location Address State Name: 
WI
    Provider Business Practice Location Address Postal Code: 
53792-2424
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
608-263-8060
    Provider Business Practice Location Address Fax Number: 
608-262-7679
    Provider Enumeration Date: 
03/25/2015