Organization
VAO SERVICE PROVIDER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN WILSON (EXECUTIVE DIRECTOR)
(405) 605-6353
Entity
Organization
Contact information
Practice address
817 SW 59TH ST, OKLAHOMA CITY, OK 73109-4807
(405) 605-6353
Mailing address
817 SW 59TH ST, OKLAHOMA CITY, OK 73109-4807
(405) 605-6353
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
AL5534
OK
Other
Enumeration date
08/19/2010
Last updated
08/19/2010
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