Individual
CHARLES LEE KETNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5807 NW KINYON AVE, LAWTON, OK 73505-4629
(580) 215-3435
Mailing address
5807 NW KINYON AVE, LAWTON, OK 73505
(580) 215-3435
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
09/05/2012
Last updated
09/05/2012
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