Individual
DEMETRIA LAVONNA TRYON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
57533 MOCCASIN TRAIL RD, PRAGUE, OK 74864-1143
(405) 567-0054
Mailing address
2433 NW 109TH ST, OKLAHOMA CITY, OK 73120-7211
(405) 590-7683
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
09/27/2011
Last updated
09/27/2011
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