| NPI | 1720056492 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER LEIGH MONTGOMERY Executive Director 563-243-1413 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2022-11-28 |