Provider First Line Business Practice Location Address:
8701 W WATERTOWN PLANK RD
Provider Second Line Business Practice Location Address:
PSYCHIATRY DEPARTMENT, TOSA CENTER
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53226-3548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-955-8990
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2008