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Individual

TERESA JANETTE RUNYON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
801 E MAIN ST, TISHOMINGO, OK 73460-2351
(918) 967-8692
(918) 967-8698
Mailing address
507 NE 4TH ST, STIGLER, OK 74462-1919
(918) 471-9261
(918) 967-8698

Taxonomy

Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary

Other

Enumeration date
08/27/2012
Last updated
10/22/2012
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