Provider First Line Business Practice Location Address:
MEDICAL FAMILY THERAPY
Provider Second Line Business Practice Location Address:
817 E. 6TH ST.
Provider Business Practice Location Address City Name:
TISHOMINGO
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-387-2719
Provider Business Practice Location Address Fax Number:
580-387-2728
Provider Enumeration Date:
03/12/2007