NPI | 1104933696 |
---|---|
Entity Type | Organization |
Authorized Contact | TERI S FORMANEK President 515-327-1555 |
Organization Subpart ? | No |
Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: na) |
Enumeration Date | 2006-08-23 |
Last Update Date | 2020-06-04 |