| NPI | 1912189408 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATTY A O'NEILL Office Manager 563-568-0088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IA A05912) |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2007-11-27 |