| NPI | 1538839618 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS W JOHNSON Reimbursement Manager 262-928-4704 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2021-09-20 |
| Last Update Date | 2022-05-23 |