| NPI | 1639351331 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY J COPPOLA Owner 515-967-4252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IA 02453) |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2007-12-04 |