| NPI | 1861873085 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIMMY LEE TISDALE Owner 405-470-1224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: OK F0613916) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2020-02-13 |