| NPI | 1215388632 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE A MICHAUD Owner 913-808-5275 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: KS 04-36559) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: KS 04-36559) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2017-03-23 |