Individual
LARETHA JOHNSON-VINCENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
125 N OKLAHOMA AVE, MANGUM, OK 73554-4279
(713) 876-0839
Mailing address
125 N OKLAHOMA AVE, MANGUM, OK 73554-4279
(713) 876-0839
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
09/13/2018
Last updated
09/13/2018
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