| NPI | 1205928553 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS A JOHNSON President 262-782-4270 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: WI 26997) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2020-08-22 |