| NPI | 1912158445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDITH COTTON Credentials Manager 913-684-6562 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1100X Clinic/Center, MilitaryU.S. Coast Guard Outpatient (Licence: PA 22525123) |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2008-10-02 |