| NPI | 1275075103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELBY ANN HEATWOLE Head Athletic Trainer 620-290-4687 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: KS XSB886824257) |
| Enumeration Date | 2016-11-09 |
| Last Update Date | 2016-11-09 |