| NPI | 1184358004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CALEB JENSEMA CFO 920-783-6633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-07-15 |
| Last Update Date | 2022-07-15 |