Individual
LACY CLEMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1010 E 45TH ST, SHAWNEE, OK 74804-2202
(405) 273-1170
Mailing address
1010 E 45TH ST, SHAWNEE, OK 74804-2202
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
02/08/2008
Last updated
02/08/2008
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