| NPI | 1427350339 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE M REVELS Physician 913-484-5052 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: KS 0428042) |
| Enumeration Date | 2010-11-29 |
| Last Update Date | 2012-07-17 |