| NPI | 1962752659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN CLARK SHADE Executive Director 918-431-1818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: OK OK4140) |
| Enumeration Date | 2012-09-11 |
| Last Update Date | 2012-09-11 |