| NPI | 1700907730 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNI JO MAGGARD Administrative Assistant 918-647-4196 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2020-08-22 |