| NPI | 1023225042 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORELLE MICHELLE MANION President 262-784-3200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: WI 35609) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2020-08-22 |