| NPI | 1609012020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATASHA M THOMPSON Revenue Cycle Manager 414-964-9018 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2018-08-28 |