Provider First Line Business Practice Location Address:
121 E JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANGUM
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73554-4242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-782-5314
Provider Business Practice Location Address Fax Number:
580-782-2648
Provider Enumeration Date:
04/27/2006