| NPI | 1639355043 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONNYE CARROLLE BROWN Owner 816-309-0715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MO L125348009) |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2008-01-16 |