| NPI | 1437327475 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN A. HANSEN Sole Proprietor 920-499-1177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric (Licence: WI 403-025) |
| Enumeration Date | 2008-02-12 |
| Last Update Date | 2008-02-12 |