| NPI | 1659810703 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY A WILSON Nurse Adminstrator 414-574-0253 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2017-02-21 |
| Last Update Date | 2024-06-13 |