| NPI | 1134543101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA A SWEENEY CFO/Secretary/Treasurer 262-834-6130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2014-02-12 |
| Last Update Date | 2014-02-12 |