| NPI | 1316600737 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANNICE MARIE TAYLOR Provider 641-223-8365 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QP2400X Clinic/Center, Prison Health | |
| Enumeration Date | 2021-10-21 |
| Last Update Date | 2022-02-09 |