| NPI | 1073832440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ROSSANO Director 715-345-1965 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WI 1320) |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2010-05-25 |