| 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 |