| NPI | 1104131960 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN C. MATTEUCCI Facility Director 262-653-9221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2010-08-17 |
| Last Update Date | 2010-08-17 |