Provider First Line Business Practice Location Address:
RT 1 BOX 1
Provider Second Line Business Practice Location Address:
LOMEGA ELEMENTARY SCHOOL
Provider Business Practice Location Address City Name:
LOYAL
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-729-4251
Provider Business Practice Location Address Fax Number:
405-729-4252
Provider Enumeration Date:
02/26/2007