| NPI | 1710107529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HETLEVIA R JENSEN Physician Owner 580-225-2269 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 23895) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2020-08-22 |