| NPI | 1891980231 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARMEN MARIE JOHNS Office Manager 414-321-2273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: WI 2547-012) |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2007-09-10 |