| NPI | 1528204567 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMALA ROCHELLE MALLETT MOORE Owner/Medical Doctor 580-772-2400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 26755) |
| Enumeration Date | 2008-12-22 |
| Last Update Date | 2011-01-24 |