| NPI | 1417789272 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW ALLEN LAWRENCE Owner 918-809-6133 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2024-08-19 |
| Last Update Date | 2024-10-11 |