| NPI | 1629766407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA S BRISCOE Manager 918-808-7626 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2023-04-28 |
| Last Update Date | 2025-12-04 |