NPI
LastName
FirstName
MidName
Organization
Mailing Address
City
State
Zip
1205466372
GRAND LAKE MENTAL HEALTH CENTER, INC
114 W DELAWARE AVE
NOWATA
OK
740482601
1912531344
GRAND LAKE MENTAL HEALTH CENTER, INC.
114 W DELAWARE AVE
NOWATA
OK
740482601
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