| NPI | 1306257829 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROXIE ANN SMITH AO Da Counelor 414-744-5370 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: WI 15855-130) |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2014-05-19 |