| NPI | 1346793643 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA L PARKS Md 402-228-4295 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NE 20911) |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2016-08-03 |