| NPI | 1891167060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL MERLE ULBERG President 918-809-8164 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OK 4429) |
| Enumeration Date | 2015-10-27 |
| Last Update Date | 2015-10-27 |