Provider First Line Business Practice Location Address:
FORWARD FAMILY THERAPY, LLC
Provider Second Line Business Practice Location Address:
10535 N PORT WASHINGTON ROAD, SUITE 204
Provider Business Practice Location Address City Name:
MEQUON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-324-0718
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2010