| NPI | 1619262615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL DAVID RILEY Owner 620-342-7768 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: KS 04-23070) |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2011-06-17 |