| NPI | 1891053922 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN ALAN MILLER Owner 620-251-0777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: KS 0521872) |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2012-04-26 |