| NPI | 1194230656 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATIE HOFTENDER Credentialing Coordinator 563-583-7357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2017-12-06 |
| Last Update Date | 2017-12-06 |