| NPI | 1730600131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANCE L TEACHWORTH Sole Member 785-875-3010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: KS 01-04366) |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2017-07-06 |