| NPI | 1457788242 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL OWEN Clinic Owner 262-707-4671 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2013-10-11 |
| Last Update Date | 2025-05-07 |