| NPI | 1790312171 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY K FRIESS President 920-579-1027 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 104100000X Social Worker |
| 207QG0300X Family Medicine Geriatric Medicine | |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2022-09-22 |