| NPI | 1033115456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEAH NEWTON Billing Manager 715-622-0293 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: WI 32957000) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2022-09-01 |