| NPI | 1447661590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY A BACKHAUS Owner 414-690-1426 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: IL 038.012607) |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2014-05-12 |