| NPI | 1760035513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE D RUTH Implementation & Training COO Rd 262-375-2827 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2019-07-22 |