Individual
CHASITEE QWINETTE BURDINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
57533 MOCCASIN TRAIL RD, PRAGUE, OK 74864
(405) 567-0054
Mailing address
1201 N UNION AVE, SHAWNEE, OK 74801-5022
(405) 650-7738
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
07/27/2010
Last updated
08/30/2018
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