| NPI | 1609376193 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOYCE ANN GILLIS Owner 816-305-0839 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: KS 00845479) |
| Additional Taxonomies | 251S00000X (Licence: MO 00845479) |
| 251S00000X | |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2018-06-16 |