| NPI | 1992414155 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER CAIN Billing/Credentialing Manager 918-960-2827 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2022-11-16 |
| Last Update Date | 2022-11-16 |