| NPI | 1740366749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY G FRUIT Executive Director 608-347-6649 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: NY 051111032) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2022-12-15 |