| NPI | 1720090236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRIS M SPANGENBERG Administrative Assistant 715-243-6973 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 020) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2012-10-01 |