| NPI | 1902629363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY ADAMS Medical Clinic Coordinator 920-425-4140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2024-11-04 |
| Last Update Date | 2024-11-12 |