| NPI | 1174273890 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PANH N SONG Owner 920-264-5173 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-03-25 |
| Last Update Date | 2022-10-26 |