| NPI | 1477879468 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN WEXLER Owner 262-691-7562 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: WI 4403-012) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: WI 4403-012) |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2010-04-15 |