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1639565153
RYIAN CRENSHAW
PONCA CITY, OK
NPI
1639565153
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
305S00000X Point of Service
(Licence: OK 1069)
Enumeration Date
2015-04-10
Last Update Date
2021-03-30
Business Address
RYIAN CRENSHAW
410 FAIRVIEW AVE
PONCA CITY, OK 74601-1922
Phone number: 580-749-4227
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Mailing Address
RYIAN CRENSHAW
410 FAIRVIEW AVE
PONCA CITY, OK 74601-1922
Phone number: 580-749-4227
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