| NPI | 1154875573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH GUCWA Director Of Purchasing And Faciliti 918-779-7416 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2016-08-15 |