| NPI | 1770237620 |
|---|---|
| Other Name | VINTAGE WELLNESS CLINIC |
| Entity Type | Organization |
| Authorized Contact | JOSE AREVALO Nurse Practitioner/Medical Provider 918-978-9601 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2022-02-09 |
| Last Update Date | 2022-02-09 |