| NPI | 1639427214 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROOKE B LEWIS Director 816-805-3974 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MO LC1153679) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2012-08-29 |