| NPI | 1053794412 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLTON KAMINSKI Owner 715-952-1422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: WI 4988-12) |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2015-07-02 |