| NPI | 1174924443 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK S HOLCOMB Member 913-909-9125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: IA 04-17246) |
| Enumeration Date | 2014-09-05 |
| Last Update Date | 2015-06-02 |