Provider First Line Business Practice Location Address:
124 E MAIN ST SUITE 2
Provider Second Line Business Practice Location Address:
THE CHICKASAW NATION DEPT OF FAMILY SERVICES
Provider Business Practice Location Address City Name:
ADA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-310-7993
Provider Business Practice Location Address Fax Number:
405-878-4708
Provider Enumeration Date:
08/18/2009