| NPI | 1487834156 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TUCKER ANTHONY EMERSON Co Owner 920-246-8470 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WI 4342-012) |
| Enumeration Date | 2007-11-09 |
| Last Update Date | 2007-11-09 |