| NPI | 1770894164 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENNIS MICHAEL O'DONNELL Clinician 608-370-3807 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WI 3669-012) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2011-05-13 |