| 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 |