| NPI | 1942331061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTI BOMGREN Credentialing COO Rdinator 580-323-0232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 20775) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2011-04-29 |