| NPI | 1740374230 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN E. KELLY President 262-567-6927 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: WI 24545) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2020-08-22 |