| NPI | 1093157349 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS ANDERSEN Regional President 414-465-3721 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: WI 5358-33) |
| Enumeration Date | 2013-07-26 |
| Last Update Date | 2017-10-23 |