Organization
ALL 4 ME & MOMMY PNCC CCC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARIKO MEKVABISHVILI (PRESIDENT)
(414) 745-3146
Entity
Organization
Contact information
Practice address
11051 N TOWNE SQUARE RD, MEQUON, WI 53092-5051
(414) 755-2103
Mailing address
11051 N TOWNE SQUARE RD, MEQUON, WI 53092-5051
(414) 755-2103
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
10/20/2021
Last updated
10/22/2021
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