| NPI | 1104418151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN KELLY Manager Of LLC 405-928-2727 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QH0002X Family Medicine Hospice and Palliative Medicine |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2024-04-01 |