| NPI | 1962970004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEB ODEIN LEE Exec. Dir. Clinical Operations 515-239-4452 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2018-11-07 |
| Last Update Date | 2018-11-07 |