| NPI | 1366518433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONNESHA JEFFERSON Ubo Manager 913-684-6048 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1100X Clinic/Center, MilitaryU.S. Coast Guard Outpatient |
| Additional Taxonomies | 261QM1101X Clinic/Center, Military and U.S. Coast Guard Ambulatory Procedure |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2025-05-21 |