| NPI | 1588904270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FAITH L KEEFER Billing 920-886-0818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: WI 42143020) |
| Additional Taxonomies | 261Q00000X (Licence: WI 421430202) |
| Enumeration Date | 2013-02-18 |
| Last Update Date | 2013-02-18 |