| NPI | 1548575806 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE C WALLACE Owner 918-344-4848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OK 2449) |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2010-08-11 |