| NPI | 1184234163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATALIA KINNEY Credentialing Coordinator 262-228-8002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2020-08-05 |
| Last Update Date | 2024-04-03 |