| NPI | 1497177729 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATIE HOFTENDER Credentialing/Medical Specialist 563-362-3413 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2014-01-06 |
| Last Update Date | 2025-09-17 |