NPI | 1912535022 |
---|---|
Entity Type | Organization |
Authorized Contact | MICHAEL JOSEPH SUEVDENS Medical Director 608-366-5343 |
Organization Subpart ? | No |
Primary Taxonomy | 251V00000X Voluntary or Charitable |
Additional Taxonomies | 261Q00000X Clinic/Center |
3336C0002X Pharmacy, Clinic Pharmacy | |
Enumeration Date | 2020-04-01 |
Last Update Date | 2020-04-02 |