Organization
AEON GROUP HST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PENNY T GRUNDER (PROJECT MANAGER)
(563) 386-1904
Entity
Organization
Contact information
Practice address
1801 E 54TH ST, SUITE 200, DAVENPORT, IA 52807-7209
(563) 386-1904
(866) 899-2592
Mailing address
1801 E 54TH ST, SUITE 200, DAVENPORT, IA 52807-7209
(563) 386-1904
(866) 899-2592
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
IA
Other
Enumeration date
09/10/2012
Last updated
09/10/2012
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