| NPI | 1770036923 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL VIRGINIA MCNUTT Agent 414-797-2155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WI 125-3943) |
| Enumeration Date | 2016-07-24 |
| Last Update Date | 2016-07-24 |