Provider First Line Business Practice Location Address:
5000 W NATIONAL AVE
Provider Second Line Business Practice Location Address:
MENTAL HEALTH DIVISION
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53295-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-342-2224
Provider Business Practice Location Address Fax Number:
414-342-2207
Provider Enumeration Date:
08/05/2006