| NPI | 1376719716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ARLETA SPYCE STOVER Owner 580-383-4357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: OK 3569) |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2008-05-06 |