| NPI | 1326701038 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVELYN MARIE TUSTIN Manager 918-647-0670 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 213E00000X Podiatrist |
| Enumeration Date | 2021-10-19 |
| Last Update Date | 2021-10-19 |