NPI | 1922400563 |
---|---|
Entity Type | Organization |
Authorized Contact | AMANDA DEREMO Employer 608-449-1399 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: WI 318603) |
Enumeration Date | 2014-09-25 |
Last Update Date | 2014-09-25 |