| NPI | 1760852495 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN ODEGAARD Administrator 414-289-3796 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: WI 148911-32) |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2015-10-07 |