Provider First Line Business Practice Location Address:
230 E JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANGUM
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73554-4202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-782-2552
Provider Business Practice Location Address Fax Number:
580-782-9266
Provider Enumeration Date:
07/28/2006