| NPI | 1013556638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEE HOMAN CEO 715-392-1955 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-12-30 |
| Last Update Date | 2024-02-13 |