| NPI | 1124550405 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE WILLIAM CARDONE Medical Director 262-349-9371 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2017-03-28 |