Individual
TERESA L CRANDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
104 S MORTON AVE, OKMULGEE, OK 74447-5022
(918) 756-2111
Mailing address
104 S MORTON AVE, OKMULGEE, OK 74447-5022
(918) 756-2111
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
12/27/2006
Last updated
07/08/2007
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