| NPI | 1215823406 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN WILLIAM STAMPFL CFO 262-771-3561 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2025-06-16 |
| Last Update Date | 2025-06-16 |