Individual
EBONYE PATRICE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1704 CENTER DR APT 2, MIDWEST CITY, OK 73110-2869
(405) 679-7979
Mailing address
1704 CENTER DR APT 2, MIDWEST CITY, OK 73110-2869
(405) 679-7979
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
07/02/2018
Last updated
07/02/2018
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