| NPI | 1629491105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER L BOOMGARDEN Physicians Practice Manager 816-629-2623 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0000X Family Medicine, Adolescent Medicine (Licence: MO R6J43) |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2014-02-04 |