| NPI | 1609246511 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDY ENGEVOLD Manager 414-425-8700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: WI 6617) |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2015-10-05 |