Provider First Line Business Practice Location Address:
9 ODANA COURT
Provider Second Line Business Practice Location Address:
SUITE 203 UPLANDS COUNSELING
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53719-1122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-274-5181
Provider Business Practice Location Address Fax Number:
608-274-2848
Provider Enumeration Date:
06/18/2006