| NPI | 1447598719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN EFFERTZ Owner 608-512-8862 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IA 007431) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: IA 007413) |
| Enumeration Date | 2013-01-22 |
| Last Update Date | 2013-03-26 |