| NPI | 1982887253 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOIS J JACOBS President 920-231-5313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty (Licence: WI 30302) |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2008-02-07 |