| NPI | 1417692815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY ANN TOTTEN-GILBERT Owner 918-497-8138 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2022-04-29 |
| Last Update Date | 2024-06-18 |