| NPI | 1477095099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS HENDERSON Owner 515-597-4022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IA 081193) |
| Enumeration Date | 2016-11-14 |
| Last Update Date | 2017-03-13 |