| NPI | 1164700027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GENEVIE LOREE KOCOUREK Director/Owner 414-427-1577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 53754) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2011-08-15 |