| NPI | 1861279804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARQUITTA FRAZIER Credentialing Specialist 405-425-0442 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2023-09-13 |
| Last Update Date | 2023-09-13 |