| NPI | 1740535368 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANNEN FERRELL CEO 918-260-2093 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2023-05-31 |