| NPI | 1659735504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINA NEGRETTE Owner 262-751-3730 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: WI 5214820) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2016-04-07 |