| NPI | 1114346574 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAIL WILEY Manager Of Operations 715-820-0543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL ME54115) |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services (Licence: FL ME47330) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2014-09-11 |