| NPI | 1740320548 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOE C MONSOUR Operator 620-365-6002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: KS N001-006) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2020-08-22 |