| NPI | 1063652725 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHELLE HARJO Clinical Director 405-315-4990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: OK 3646) |
| Additional Taxonomies | 251S00000X (Licence: NM 0073851) |
| 251S00000X (Licence: OK Candidate LADC) | |
| Enumeration Date | 2009-02-20 |
| Last Update Date | 2010-08-15 |