| Provider Type: | Student, Health Care |
| Provider Classification: | Student in an Organized Health Care Education/Training Program |
| Definition of Specialization: | |
| Address: |
3905 S Hudson Ave Tulsa, OK 74135-5607 |
| Phone: | (918) 627-3390 |
| Fax: | (918) 664-2134 |
| Gender: | Male |
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