| NPI | 1679111454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIJUA WATSON COO 414-238-4596 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QG0250X Clinic/Center, Genetics | |
| 261QH0100X Clinic/Center, Health Services | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 261QP0905X Clinic/Center, Public Health, State or Local | |
| Enumeration Date | 2019-12-12 |
| Last Update Date | 2019-12-12 |