| NPI | 1770760480 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARILYN ANN MARCHESE Practice Manager 262-251-8447 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: WI 23216) |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2008-02-20 |