| NPI | 1497905129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA JEANNE BARNETT-WAMBOLDT President 262-697-3665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: WI 2407-035) |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2009-01-28 |