| NPI | 1164060158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN ROADHOUSE Owner, Authorized Official 918-481-2772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207K00000X Allergy & Immunology |
| Enumeration Date | 2019-12-20 |
| Last Update Date | 2024-03-26 |