| NPI | 1700234978 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH RASIMUS CEO 262-421-5133 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: WI 52008-20) |
| Enumeration Date | 2016-05-29 |
| Last Update Date | 2024-12-11 |