| NPI | 1851751135 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP A BLACK Owner 918-605-8614 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OK 2649) |
| Enumeration Date | 2016-03-01 |
| Last Update Date | 2016-03-01 |