Provider First Line Business Practice Location Address:
100 COUNTY RD B
Provider Second Line Business Practice Location Address:
BEHAVIORAL HEALTH SHAWANO
Provider Business Practice Location Address City Name:
SHAWANO
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54166-7072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-720-2300
Provider Business Practice Location Address Fax Number:
920-720-3806
Provider Enumeration Date:
10/16/2006