Provider First Line Business Practice Location Address:
1600 N PHILLIPS AVE
Provider Second Line Business Practice Location Address:
COAH NUTRITION COUNSELING
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73104-4619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-271-2113
Provider Business Practice Location Address Fax Number:
405-271-1560
Provider Enumeration Date:
08/25/2005