| NPI | 1902570021 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER BAHNMAIER Insurance Credentialing Specialist 785-505-2988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2021-08-03 |
| Last Update Date | 2024-05-22 |