Provider First Line Business Practice Location Address:
LUBBIS ST
Provider Second Line Business Practice Location Address:
2 MI NE OF COALGATE OK ON STATE HWY 31
Provider Business Practice Location Address City Name:
COTTONWOOD
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74538-0347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-927-2937
Provider Business Practice Location Address Fax Number:
580-927-2938
Provider Enumeration Date:
01/30/2006