| NPI | 1669991485 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN S GILLIAM Medical Director 405-590-8861 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 41469) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: AZ AP3224) |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2017-09-13 |