Provider First Line Business Practice Location Address:
100 S BLISS AVE
Provider Second Line Business Practice Location Address:
DEPT OF PSYCHIATRY
Provider Business Practice Location Address City Name:
TAHLEQUAH
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74464-2512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-858-0066
Provider Business Practice Location Address Fax Number:
504-613-4913
Provider Enumeration Date:
12/14/2006