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 |