Provider First Line Business Practice Location Address:
601 W DAYTON ST
Provider Second Line Business Practice Location Address:
THE KOHL CENTER - BADGERS SPORTS MEDICINE
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53715-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-265-5698
Provider Business Practice Location Address Fax Number:
608-265-4290
Provider Enumeration Date:
06/12/2009