| NPI | 1215325782 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN C ANDERSON Doctor/Member 262-646-2640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: WI 5057-12) |
| Enumeration Date | 2015-01-06 |
| Last Update Date | 2015-01-06 |