| NPI | 1174071658 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY S MCHUGH-COFFEY Executive Director 262-764-3608 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2016-09-14 |