| NPI | 1710139076 |
|---|---|
| Doing Business As | SOUTHSIDE MEDICAL |
| Entity Type | Organization |
| Authorized Contact | CHRISTOPER VINCENT MOSES Physician 918-493-3838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2008-10-17 |
| Last Update Date | 2008-11-11 |