Organization
THE BREAST CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MONIQUE C PRESTON (EXEC. CORP. DIRECTOR)
(580) 536-9729
Entity
Organization
Contact information
Practice address
5604 SW LEE BLVD, SUITE 150, LAWTON, OK 73505-9681
(580) 536-9729
(580) 536-2584
Mailing address
5604 SW LEE BLVD, SUITE 150, LAWTON, OK 73505-9681
(580) 536-9729
(580) 536-2584
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
141952
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141952
FDA NUMBER
OK
Enumeration date
07/13/2006
Last updated
08/22/2020
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