| NPI | 1457751893 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA MARIE SMITH Therapist 414-795-6833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Additional Taxonomies | 302R00000X Health Maintenance Organization |
| Enumeration Date | 2014-09-03 |
| Last Update Date | 2014-09-03 |