| NPI | 1508085879 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRI ANN COSSELMAN Administrator 641-357-7083 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: IA S0166) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2020-08-22 |