Individual
KENNETH WILLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
416 N FOREST RIDGE BLVD, BROKEN ARROW, OK 74014-2758
(918) 698-9246
Mailing address
416 N FOREST RIDGE BLVD, BROKEN ARROW, OK 74014-2758
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/24/2016
Last updated
08/24/2016
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