| NPI | 1871148908 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY MONTGOMERY Practice Manager 918-346-3094 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2019-08-06 |