Individual
STEPHANIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2917 S ASH CT, BROKEN ARROW, OK 74012-7804
(918) 849-5390
Mailing address
2917 S ASH CT, BROKEN ARROW, OK 74012-7804
(918) 849-5390
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
02/09/2015
Last updated
02/09/2015
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