| NPI | 1194144709 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLE D GRAVES Owner 918-285-0947 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OK 5025, 1065) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2022-04-28 |