| NPI | 1215121967 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL JEAN BURKS Member 920-430-9100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WI 2480) |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2007-09-05 |