| NPI | 1043204852 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA THERESE CHLADEK Practice Manager 913-661-9980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2024-10-23 |