| NPI | 1245692896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY F GOGGINS Chief Medical Officer/Physician 920-749-1171 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2017-02-07 |