| NPI | 1982743498 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY CHARLES Administrator 608-296-3811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: WI 241) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2020-08-22 |