| NPI | 1881747806 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN MARK RICCITELLI Physician Owner 580-248-1199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 2220) |
| Enumeration Date | 2007-01-21 |
| Last Update Date | 2007-10-24 |