| NPI | 1114258886 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLEN BRUCE JETMORE Sole Member 913-829-7716 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: KS 04-24436) |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2010-12-23 |