| NPI | 1518651868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY L BOSTIC Owner / Director 918-671-1148 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2023-06-07 |
| Last Update Date | 2023-06-07 |