| NPI | 1366139040 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIERRA J PAGE Owner/President 405-209-2083 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2023-04-21 |
| Last Update Date | 2023-04-23 |