| NPI | 1679657753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL L TEBO Corporate Administrator 515-224-5131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IA ACR0340900992) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2020-08-22 |