| NPI | 1477570380 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWNA BLACKMON Office Supervisor 816-836-4770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 35847) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2007-10-16 |