| NPI | 1952003618 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAHA SIDERS Chief Operating Officer 262-577-0250 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2023-03-20 |