| NPI | 1851775746 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN L DERONDE Corporate Administrator 515-224-1414 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 078992) |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2015-07-10 |