| NPI | 1003336884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL MARIE ULLMER Owner 920-277-6989 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty (Licence: WI CLIE-AHZQT3) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2017-06-22 |