Individual
LEISA BLOSSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
500 WEST CHINCAPIN, WESTVILLE, OK 74965
(918) 723-3181
Mailing address
PO BOX 410, WESTVILLE, OK 74965-0410
(918) 723-3181
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
OK
Other
Enumeration date
05/26/2016
Last updated
05/26/2016
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