| NPI | 1013610641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW JOHNSON Managing Member 715-268-8121 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 3336C0002X Pharmacy, Clinic Pharmacy |
| Enumeration Date | 2023-03-23 |
| Last Update Date | 2025-08-06 |