| NPI | 1023064086 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYLE A. IGNACE Executive Director 414-383-9526 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2024-12-05 |