| NPI | 1598145211 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERYL G FULLEN Member/Manager/Owner 620-222-6210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: KS 4-16478) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2015-06-08 |