Provider First Line Business Practice Location Address:
2611 12TH ST S
Provider Second Line Business Practice Location Address:
MENTAL HEALTH AODA CLINIC
Provider Business Practice Location Address City Name:
WISCONSIN RAPIDS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-421-8849
Provider Business Practice Location Address Fax Number:
715-421-2266
Provider Enumeration Date:
11/28/2006