Provider First Line Business Practice Location Address:
5800 N BAYSHORE DRIVE
Provider Second Line Business Practice Location Address:
SUITE A250 NORTH SHORE PSYCHOTHERAPY ASSOCIATES
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-962-6764
Provider Business Practice Location Address Fax Number:
414-962-6765
Provider Enumeration Date:
11/30/2006