| NPI | 1790169522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBERAH KAY PETERSON Director Of Clinical Services 414-510-6084 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: WI 4100-123) |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2015-07-10 |