| NPI | 1396970976 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | INGRID WORRELL JACKSON Owner/President 405-473-7927 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 15786) |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2009-05-26 |