| NPI | 1760916779 |
|---|---|
| Doing Business As | SELF |
| Entity Type | Organization |
| Authorized Contact | ROBERT DEAN FORKNER Myself 515-729-9350 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: IA 483062595) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2017-04-17 |