| NPI | 1902342868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICKOLAS HANNA Owner 608-208-8022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine |
| Enumeration Date | 2017-01-16 |
| Last Update Date | 2023-11-08 |