| NPI | 1497034078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY BUEGE Manager 414-559-8915 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: WI 2653) |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2011-08-12 |