| NPI | 1770862054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEX P COLQUE President And CEO 262-781-9000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WI 55219020) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2020-02-03 |