| NPI | 1336706118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SERENA B WILSON Owner 918-961-1658 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP3300X Clinic/Center Pain |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2019-05-28 |