| NPI | 1730556978 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATASHA THOMPSON Revenue Cycle Manager 414-727-6315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2015-08-24 |