Individual
KEVIN EDMONDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1350 S MULDROW ST, TISHOMINGO, OK 73460-3278
(580) 579-9939
Mailing address
1350 S MULDROW ST, TISHOMINGO, OK 73460-3278
(580) 579-9939
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/28/2013
Last updated
03/28/2013
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