| NPI | 1386832228 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIANO L ROSALES JR President 920-324-3559 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WI 2190620) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: WI 2190120) |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2007-10-04 |