| NPI | 1407021900 |
|---|---|
| Doing Business As | JACKSON STREET |
| Entity Type | Organization |
| Authorized Contact | THERESA FOSBINDER Patient Services 414-289-3762 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA0005X Clinic/Center, Ambulatory Family Planning Facility |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2008-04-25 |
| Last Update Date | 2012-12-18 |