| 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 |