| NPI | 1821393323 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH DISMUKE Manager 405-524-5525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: OK 101ya0400x) |
| Enumeration Date | 2011-01-14 |
| Last Update Date | 2011-01-18 |