| NPI | 1215642285 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN HANSON President 262-716-7580 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2023-01-13 |
| Last Update Date | 2023-01-13 |