Provider First Line Business Practice Location Address:
1 S PARK ST, 7TH FLOOR
Provider Second Line Business Practice Location Address:
DEPARTMENT OF DERMATOLOGY,UNIVERSITY OF WISCONSIN
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53715-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-287-2620
Provider Business Practice Location Address Fax Number:
608-287-2676
Provider Enumeration Date:
07/22/2011