| NPI | 1609015569 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN PATRICK KISER Md 920-265-8829 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WI 23110) |
| Enumeration Date | 2009-02-16 |
| Last Update Date | 2009-02-16 |