| NPI | 1972811578 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE KEITEL Owner 816-872-2463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MO 2003022197) |
| Additional Taxonomies | 251S00000X (Licence: KS 2387) |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2010-10-05 |