| NPI | 1083725139 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMINADOR T. PERIDO Owner 620-697-2155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KS KS04-16343) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS KS04-16343) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2012-07-27 |