| NPI | 1225074008 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTENE STACKER CEO 920-731-7445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2024-02-22 |