| NPI | 1619664307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW DYER Owner 918-808-5629 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QP3300X Clinic/Center, Pain | |
| Enumeration Date | 2023-04-21 |
| Last Update Date | 2025-09-17 |