| NPI | 1225806888 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRAIG CLARK Authorized Official 319-200-4266 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 3336C0002X Pharmacy, Clinic Pharmacy | |
| Enumeration Date | 2023-12-13 |
| Last Update Date | 2025-09-30 |