Provider First Line Business Practice Location Address:
13702 E. 46TH PLACE SOUTH
Provider Second Line Business Practice Location Address:
BCCHS ROSA PARKS ELEMENTARY
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-660-3614
Provider Business Practice Location Address Fax Number:
918-660-3631
Provider Enumeration Date:
07/11/2006