| NPI | 1508391020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID HUGHES CFO 920-783-6633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2017-04-21 |