| NPI | 1609599661 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERINE CASE-SALYER Provider Enrollment Specialist 405-829-2282 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2022-09-23 |
| Last Update Date | 2022-09-23 |