| NPI | 1043523566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACE MATA RUIDERA Physician/ Owner 405-732-3990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 19279) |
| Enumeration Date | 2010-07-26 |
| Last Update Date | 2010-07-26 |