Individual
CHESTER LEE KOWALSKI IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1000 YUKON AVE, YUKON, OK 73099-4690
(405) 265-4515
Mailing address
11709 TYSON CT, MIDWEST CITY, OK 73130-8413
(325) 280-3080
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/06/2024
Last updated
08/06/2024
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