| NPI | 1902224504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI ANN GOLON Authorized Official 913-682-3920 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: KS 0428097) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2023-02-22 |