| NPI | 1477964211 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY SUE EICHMAN Registered Nurse 715-377-9617 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: WI 124164-030) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2014-05-14 |