| NPI | 1063532760 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRYSTAL P LEWIS Owner 918-712-8616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: OK 3690) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2010-01-12 |