NPI | 1972760916 |
---|---|
Entity Type | Organization |
Authorized Contact | RICKY DEAN NELSON President 515-223-0602 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IA 06911) |
Enumeration Date | 2008-05-19 |
Last Update Date | 2008-05-19 |