Provider First Line Business Practice Location Address:
1415 EAST GREEN BAY ST.,
Provider Second Line Business Practice Location Address:
STE 191 SYNERGY COUNSELING SERVICES, SC
Provider Business Practice Location Address City Name:
SHAWANO
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54166-3881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-526-5466
Provider Business Practice Location Address Fax Number:
715-526-5545
Provider Enumeration Date:
10/17/2006