| NPI | 1962677088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH C ZIMMERMAN Manager 641-512-5565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IA 00049) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2008-06-23 |