| NPI | 1962510032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN SOUTHWARD Owner 580-223-9008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: OK 21988) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2021-03-04 |