| NPI | 1538238761 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL WADE KOHL Managing Member 918-265-2257 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 22918) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2010-10-29 |