| NPI | 1407109093 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA RODRIGUEZ Medical Director 414-520-3896 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: WI 43966-020) |
| Enumeration Date | 2012-10-19 |
| Last Update Date | 2022-09-29 |