| NPI | 1649553876 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISHA D HENSON Owner 405-275-0867 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: OK 22144) |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2011-09-23 |