| NPI | 1538652144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE D RUTH Implementation & Training COO Rdinat 262-330-2827 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2021-02-11 |