| NPI | 1467561506 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY J BANACH Ofc Mgr 414-235-3623 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: WI 19042) |
| Additional Taxonomies | 261QR0200X Clinic/Center, Radiology (Licence: WI XM39276) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2008-09-18 |