Provider First Line Business Practice Location Address:
112 NORTH 5TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARNSDALL
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74002-0609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-847-2558
Provider Business Practice Location Address Fax Number:
918-847-2053
Provider Enumeration Date:
04/28/2006