Individual
MRS. ELLA GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6028 NW WILLIAMS AVE, LAWTON, OK 73505-1317
(580) 919-5663
Mailing address
6028 NW WILLIAMS AVE, LAWTON, OK 73505-1317
(580) 919-5663
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
05/28/2013
Last updated
05/28/2013
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