| NPI | 1265975460 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER GLUP Business Office Manager 402-298-4555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2016-11-21 |
| Last Update Date | 2016-11-21 |