Individual
MWINDAACE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3304 W GALVESTON PL, BROKEN ARROW, OK 74012-3255
(918) 277-9744
Mailing address
3304 W GALVESTON PL, BROKEN ARROW, OK 74012-3255
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/07/2014
Last updated
09/07/2014
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