| NPI | 1255453023 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY H DEKALB Supervisor 262-787-4026 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: VI 1082) |
| Additional Taxonomies | 174400000X Specialist (Licence: VI 1321) |
| 174400000X Specialist (Licence: VI 1296) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2008-05-08 |