| NPI | 1619191251 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY BLAICH President 620-251-0604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: KS 6743) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2020-08-22 |