| NPI | 1740651579 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUSTIN GROSS Clinical Manager 563-355-0055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IA 101YA0400X) |
| Enumeration Date | 2015-10-20 |
| Last Update Date | 2015-10-20 |