Provider First Line Business Practice Location Address:
6836 S MINGO RD
Provider Second Line Business Practice Location Address:
UMAC - ATHLETIC DEPT
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74133-3310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-461-7893
Provider Business Practice Location Address Fax Number:
918-461-7899
Provider Enumeration Date:
03/27/2007