| NPI | 1558547026 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY NEIL JOHNSON President 920-921-4910 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: WI 1431) |
| Enumeration Date | 2008-01-15 |
| Last Update Date | 2008-01-15 |