| NPI | 1043515257 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGG MICHAEL GAYLORD Director 920-946-2505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology |
| Enumeration Date | 2011-01-19 |
| Last Update Date | 2011-12-06 |