| NPI | 1255510095 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE A SOLBERG Owner 262-542-5295 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: WI 2334) |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2014-04-29 |