| NPI | 1255891933 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKIE GARDNER Fiscal Services Manager 715-839-2997 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2019-03-20 |