| NPI | 1801004692 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOLENE MARIE GARVEY Managing Member 920-494-8008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: WI 4305) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2020-08-22 |