| NPI | 1568154714 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYMBERLI DARRACOTT Credentialing Specialist 262-654-5555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2023-05-25 |
| Last Update Date | 2023-05-25 |