Individual
CHARLES ELLINGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3514 NE 35TH ST, LAWTON, OK 73507-1960
(580) 284-2620
Mailing address
3514 NE 35TH ST, LAWTON, OK 73507-1960
(580) 284-2620
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
09/04/2014
Last updated
09/04/2014
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