| NPI | 1790819886 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAIL J ODEN Administrator 414-257-3322 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 213ES0131X |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2019-04-16 |