Provider First Line Business Practice Location Address:
700 NORTH HIGHWAY 82
Provider Second Line Business Practice Location Address:
LOCUST GROVE MIDDLE SCHOOL
Provider Business Practice Location Address City Name:
LOCUST GROVE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-479-5317
Provider Business Practice Location Address Fax Number:
918-479-5347
Provider Enumeration Date:
03/02/2007