Provider First Line Business Practice Location Address:
OSU UCS SCC E D KUEKES M D
Provider Second Line Business Practice Location Address:
320 STUDENT UNION
Provider Business Practice Location Address City Name:
STILLWATER
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74078-7051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-744-5458
Provider Business Practice Location Address Fax Number:
405-744-8380
Provider Enumeration Date:
11/16/2006