| NPI | 1679712400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS EDWARD GOODRICH President 262-456-1000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 28720) |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care (Licence: WI 28720) |
| Enumeration Date | 2009-02-18 |
| Last Update Date | 2014-11-25 |