| NPI | 1861546228 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERNESTO L. MARTIN Medical Director 608-313-0524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: WI 2689) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2020-08-22 |