| 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 |