| NPI | 1427483148 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDNA M TRAVIS Owner 405-843-2067 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IL n65507887231) |
| Enumeration Date | 2013-09-12 |
| Last Update Date | 2013-09-12 |