| NPI | 1316092182 |
|---|---|
| Doing Business As | GRAND LAKE PRIMARY CARE |
| Entity Type | Organization |
| Authorized Contact | RENEE JEAN RUSSELL Provider 918-786-3100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 22021) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2016-11-11 |