| NPI | 1215356753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON DURIS Co Owner 414-489-7911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: WI 4583-012) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2014-04-14 |