| NPI | 1174997589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA KAYE MAXWELL Owner 620-481-6036 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: KS 3975) |
| Enumeration Date | 2015-11-23 |
| Last Update Date | 2015-11-23 |