| NPI | 1194896886 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK SHANNON DEWAR President Owner 920-757-9999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: WI 3297) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2020-08-22 |