| NPI | 1164019485 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN MARIE BEWER Administrative Officer 262-297-7246 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 261QP3300X Clinic/Center, Pain |
| Enumeration Date | 2020-12-22 |
| Last Update Date | 2021-05-04 |