| NPI | 1700045168 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA K THIERY Manager 262-657-3668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: WI pending) |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2011-03-23 |