Individual
ANGELA ROSE JACKSON BUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1504 S OAK ST, KINGFISHER, OK 73750-4316
(405) 375-3603
Mailing address
1504 S OAK ST, KINGFISHER, OK 73750-4316
(405) 375-3603
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/21/2014
Last updated
04/21/2014
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