| NPI | 1912184466 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ETHAN VAN NORDEN Partner 620-804-0385 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: KS 05-30418) |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2008-01-28 |