| NPI | 1205473329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONYETTA L ROSS Director 414-690-0672 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2019-12-09 |
| Last Update Date | 2019-12-09 |