| NPI | 1437472172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY GERARD NICHOLSON Clinic Manager 414-727-5467 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X (Licence: WI 904-023) |
| Additional Taxonomies | 261Q00000X (Licence: WI 11224-20) |
| Enumeration Date | 2010-03-09 |
| Last Update Date | 2010-03-09 |