Provider First Line Business Practice Location Address:
5200 E I 240 SERVICE RD
Provider Second Line Business Practice Location Address:
OKLAHOMA HEART HOSPITAL SOUTH WOUND CARE CENTER
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73135-2607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-628-6405
Provider Business Practice Location Address Fax Number:
405-753-1849
Provider Enumeration Date:
02/26/2007