NPI | 1326383274 |
---|---|
Doing Business As | STATE AVENUE HEALTH CARE |
Entity Type | Organization |
Authorized Contact | MICHAEL OLSON COO 913-945-9740 |
Organization Subpart ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine |
Enumeration Date | 2012-12-04 |
Last Update Date | 2012-12-04 |