Individual
VAN GROOMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
208 W 10TH AVE, STILLWATER, OK 74074-4429
(405) 372-0508
(405) 372-0693
Mailing address
208 W 10TH AVE, STILLWATER, OK 74074-4429
(405) 372-0508
(405) 372-0693
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
02/17/2011
Last updated
02/17/2011
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