| NPI | 1770103236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTENE STACKER CEO 920-731-7445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2020-04-24 |
| Last Update Date | 2024-02-22 |