| NPI | 1265704183 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA PARKS Office Manager 580-371-3900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: OK 1124) |
| Enumeration Date | 2012-02-08 |
| Last Update Date | 2012-02-08 |