| NPI | 1659511954 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELANESE PARKS Principal Member 405-431-0232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2009-02-26 |
| Last Update Date | 2011-02-02 |