| NPI | 1497263818 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD EDWARDS Owner 918-935-3636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2018-01-19 |
| Last Update Date | 2022-11-08 |