Provider First Line Business Practice Location Address:
13850 WEST CAPITOL DRIVE WELLBROOK RECOVERY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKFIELD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-867-9579
Provider Business Practice Location Address Fax Number:
414-409-5150
Provider Enumeration Date:
10/29/2020