| NPI | 1669889283 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TREVOR NETTLES Administrator 414-273-8484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2017-05-01 |