| NPI | 1265818017 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRSTEN LYNNETTE DILLON Owner 402-880-2101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NE 10263) |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2015-08-04 |