| NPI | 1053619627 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINA MARIE CARAVAGLIA Owner 918-816-1901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: 2011-01820) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: OK 4574) |
| Enumeration Date | 2011-03-07 |
| Last Update Date | 2013-11-13 |