| NPI | 1780159004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID DICH Owner 920-415-0505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-10-13 |
| Last Update Date | 2018-10-13 |