| NPI | 1073898649 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATT IVES CFO 641-622-2720 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: IA 540100H) |
| Enumeration Date | 2011-10-14 |
| Last Update Date | 2019-10-09 |