| NPI | 1730606153 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATIE MARIE SCOTT CEO 539-424-1903 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X (Licence: OK 3808) |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2022-07-21 |