| NPI | 1689172751 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE LEE HUTCHISON Owner 563-580-0243 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QP2000X Clinic/Center, Physical Therapy | |
| Enumeration Date | 2018-01-24 |
| Last Update Date | 2018-01-24 |