| NPI | 1275953820 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL SHANE JOHNSON Owner 810-941-8245 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: OK 30380) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2014-04-22 |