Provider First Line Business Practice Location Address:
MADISON STATE HOSPITAL
Provider Second Line Business Practice Location Address:
711 GREEN RD.
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-265-7336
Provider Business Practice Location Address Fax Number:
812-265-7487
Provider Enumeration Date:
07/24/2006