| NPI | 1265435960 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY COFFEY Executive Director 262-764-3608 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health (Licence: WI None) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 122300000X Dentist | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2014-09-09 |