| NPI | 1053814160 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY MICHAEL ROSS Owner 918-682-8631 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: OK 31424) |
| Enumeration Date | 2018-03-14 |
| Last Update Date | 2018-03-14 |