| NPI | 1316059496 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA K MATHIS-PRICE Credentialing Specialist 563-526-8637 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251V00000X Voluntary or Charitable |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2024-02-08 |