| NPI | 1700183829 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA LYNN TUSTIN Owner 918-649-0772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OK 4265) |
| Enumeration Date | 2011-02-25 |
| Last Update Date | 2011-02-25 |