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Organization
MISSION STREET MEDICAL CLINIC INC
Active
Organization
MISSION STREET MEDICAL CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANNA M WILLIS D.O. (DOCTOR)
(918) 224-9555
Entity
Organization
Contact information
Practice address
615 S MISSION ST STE A, SAPULPA, OK 74066-4635
(918) 224-9555
(918) 224-8001
Mailing address
615 S MISSION ST STE A, SAPULPA, OK 74066-4635
(918) 224-9555
(918) 224-8001
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2405
OK
Other
Enumeration date
09/20/2006
Last updated
12/30/2010
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