| NPI | 1003092214 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIRANDA S BOHLKEN Owner 563-581-2673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IA 06264) |
| Enumeration Date | 2008-01-17 |
| Last Update Date | 2009-06-12 |