| NPI | 1003116385 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICKY DARREN WIERSIG Owner 405-737-5653 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: OK 3048) |
| Enumeration Date | 2010-11-02 |
| Last Update Date | 2010-12-20 |