Provider First Line Business Practice Location Address:
721 AMERICAN AVENUE SUITE 501
Provider Second Line Business Practice Location Address:
PHC BEHAVIORAL MEDICINE CENTER
Provider Business Practice Location Address City Name:
WAUKESHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-928-2396
Provider Business Practice Location Address Fax Number:
262-544-1213
Provider Enumeration Date:
02/13/2006