Organization
STATELINE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE WALKER D.C. (OWNER)
(479) 561-2448
Entity
Organization
Contact information
Practice address
105 N POCOLA BLVD, SUITE 2, POCOLA, OK 74902-3101
(479) 561-2448
Mailing address
105 N POCOLA BLVD, SUITE 2, POCOLA, OK 74902-3101
(479) 561-2448
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
OK
Other
Enumeration date
03/22/2018
Last updated
03/22/2018
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