| NPI | 1396803060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES BERRY FULLENWIDER President 918-682-8087 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: OK 12300) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2020-08-22 |