| NPI | 1326683749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAWON HOLLEY Therapist 414-745-4554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2019-11-08 |
| Last Update Date | 2019-11-08 |