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1700928603
PRODIGY FOUNDATION
TAHLEQUAH, OK
NPI
1700928603
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Entity Type
Organization
Authorized Contact
BARRY B. AVERETT
Office Manager
918-456-8399
Organization Subpart ?
No
Primary Taxonomy
251S00000X
Enumeration Date
2007-02-14
Last Update Date
2020-08-22
Business Address
PRODIGY FOUNDATION
1024 S MUSKOGEE AVE
TAHLEQUAH, OK 74464-4734
Phone number: 918-456-8399
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Mailing Address
PRODIGY FOUNDATION
1024 S MUSKOGEE AVE
TAHLEQUAH, OK 74464-4734
Phone number: 918-456-8399
Copy
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