| NPI | 1053287029 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAKRISTA O'DELL Member / Owner 580-618-1109 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2025-10-15 |
| Last Update Date | 2025-10-22 |