| NPI | 1104819473 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES H WILKINSON Administrator 515-438-4214 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2020-08-22 |