| NPI | 1700229564 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAZRIA TRINETTE PRICE Sac It 262-497-3445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WI 16859) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2013-04-12 |