| NPI | 1285968040 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FARZANEH MASOOLTONDKAR General Practice 262-751-7496 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WI 52372-020) |
| Enumeration Date | 2009-09-28 |
| Last Update Date | 2009-09-28 |