| NPI | 1740576610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL DONIAL JACKSON President 319-350-2208 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2011-06-21 |