Individual
MICHAEL LEE SOURIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
712 NW 193RD ST, EDMOND, OK 73012-3418
(405) 340-4257
(405) 340-4257
Mailing address
712 NW 193RD ST, EDMOND, OK 73012-3418
(405) 340-4257
(405) 340-4257
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/29/2011
Last updated
08/29/2011
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