Individual
LILA MARIE ROUGHFACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
200 WHITE EAGLE DR, PONCA CITY, OK 74601-8315
(580) 749-7322
Mailing address
200 WHITE EAGLE DR, PONCA CITY, OK 74601-8315
(580) 749-0093
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
03/26/2024
Last updated
03/26/2024
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