| NPI | 1043641947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | APRIL LYNN STENDAHL Therapist/Supervisor In Training 715-845-3736 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2013-12-03 |
| Last Update Date | 2022-07-21 |