| NPI | 1174395792 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RIVA KIMMEL Operations Manager 262-672-2578 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| 207Q00000X Family Medicine | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2023-10-26 |
| Last Update Date | 2023-10-26 |