| NPI | 1740461045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER ANN KING Doctoe 262-513-7254 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: WI 3659) |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2007-11-15 |