| NPI | 1407002546 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCY ELLEN RUNNELLS Chief Financial Officer 715-204-1810 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2008-08-08 |
| Last Update Date | 2008-08-08 |