| NPI | 1013259753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA LYNNE WEGENER Owner 580-233-8333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: OK 59064-003) |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2013-03-20 |