| NPI | 1770382434 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENIFER DEZIEL Owner 715-566-1652 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208VP0000X |
| Enumeration Date | 2025-03-13 |
| Last Update Date | 2025-03-13 |