| NPI | 1740572619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA MARIE THOMPSON Owner/President 414-385-1213 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WI 48852-020) |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2011-05-10 |