NPI | 1942467915 |
---|---|
Entity Type | Organization |
Authorized Contact | GWEN PLACE Office Administrator 918-534-3170 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: OK 2719) |
Enumeration Date | 2008-05-19 |
Last Update Date | 2008-05-19 |