| NPI | 1962521716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD TERRANCE STEVENS President 262-656-0006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 22919020) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2020-08-22 |