WALLACE JACKSON CHAMPLAIN

TAHLEQUAH, OK
NPI1689648636
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207V00000X Obstetrics & Gynecology
(Licence: OK  1994)
Enumeration Date2006-02-15
Last Update Date2019-06-04
Business Address
WALLACE JACKSON CHAMPLAIN DO
1500 E DOWNING ST STE 208
TAHLEQUAH, OK 74464-3234
Phone number: 918-456-2496
Mailing Address
WALLACE JACKSON CHAMPLAIN DO
1500 E DOWNING SUITE 208
TAHLEQUAH, OK 74464-3363
Phone number: 918-456-2496
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