| NPI | 1790115954 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONYETTA L ROSS Director 414-690-0672 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WI 15896-130) |
| Enumeration Date | 2013-11-25 |
| Last Update Date | 2013-11-25 |