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1447854260
LILY GRACE SOUTHERN
TAHLEQUAH, OK
NPI
1447854260
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Enumeration Date
2020-11-23
Last Update Date
2020-11-23
Business Address
LILY GRACE SOUTHERN
16414 W 760 RD
TAHLEQUAH, OK 74464-1675
Phone number: 918-708-9009
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Mailing Address
LILY GRACE SOUTHERN
67612 S 260 RD
WAGONER, OK 74467-6250
Phone number: 918-688-8801
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