| NPI | 1669911277 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA FERRA Manager 414-207-1058 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: WI 23313) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: WI 23313) |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2017-02-15 |