| NPI | 1396385431 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLEY HENTHORN Credentialing 405-237-3770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QM2500X Clinic/Center Medical Specialty |
| Enumeration Date | 2020-01-07 |
| Last Update Date | 2025-08-05 |