| NPI | 1528204682 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROY OSTENSON President 920-731-0715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: WI 1369-012) |
| Enumeration Date | 2008-12-19 |
| Last Update Date | 2008-12-19 |