| NPI | 1164276374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TREVOR T WILD Authorized Official 515-250-5554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2024-04-15 |
| Last Update Date | 2024-04-15 |