| NPI | 1649520008 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK V LORSON CEO 414-207-0309 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QP0905X Clinic/Center, Public Health, State or Local |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2012-09-13 |