Provider First Line Business Practice Location Address:
301 TROY DRIVE
Provider Second Line Business Practice Location Address:
MENDOTA MENTAL HEALTH INSTITUTE GTU
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-301-1245
Provider Business Practice Location Address Fax Number:
608-301-1434
Provider Enumeration Date:
08/21/2006