Provider First Line Business Practice Location Address:
1001 NORTH COUNTRY CLUB RD
Provider Second Line Business Practice Location Address:
CARL ALBERT HOSPITAL I M DEPT
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:
580-421-4581
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2007