| NPI | 1639317167 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLEON EDWARD SUGGS Clinical Supervisor 414-688-3062 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: WI 11828134) |
| Additional Taxonomies | 251S00000X (Licence: WI 10600132) |
| Enumeration Date | 2009-01-21 |
| Last Update Date | 2009-01-21 |