| NPI | 1639193212 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBBECCA ZILLMER Manager 414-301-6384 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2020-03-25 |