Individual
KELLY BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1501 S VIRGINIA AVE, ATOKA, OK 74525-3233
(580) 889-3799
Mailing address
150 S VIRGINIA, ATOKA, OK 74525
(580) 889-3799
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
02/08/2010
Last updated
02/08/2010
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