Provider First Line Business Practice Location Address: 
OUTAGAMIE COUNTY HEALTH AND HUMAN SERVICES
    Provider Second Line Business Practice Location Address: 
320 S. WALNUT ST.
    Provider Business Practice Location Address City Name: 
APPLETON
    Provider Business Practice Location Address State Name: 
WI
    Provider Business Practice Location Address Postal Code: 
54911
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
920-832-5270
    Provider Business Practice Location Address Fax Number: 
920-832-5488
    Provider Enumeration Date: 
02/27/2019