| NPI | 1467631903 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANNIE M MC CANCE Owner 918-687-1634 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: OK 16881) |
| Enumeration Date | 2007-11-01 |
| Last Update Date | 2007-11-13 |