Individual
MR. GARY EARL WILBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 N 6TH ST, PONCA CITY, OK 74601-2827
(580) 762-7561
Mailing address
2201 DONNER AVE, PONCA CITY, OK 74604-2708
(580) 765-4887
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/05/2010
Last updated
04/05/2010
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