| NPI | 1215916184 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN ADAM VANRAALTE Owner 563-322-8877 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: IA 29526) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2010-02-15 |