Individual
THEDA EDWARDS-LABOME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OWNER/BILLER/CODER
Contact information
Practice address
15402 BLUERIDGE CT, MISSOURI CITY, TX 77489-2606
(832) 398-2707
(832) 770-4396
Mailing address
PO BOX 1404, MISSOURI CITY, TX 77459-1404
(832) 398-2707
(832) 770-4396
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
0000000000
TX
Other
Enumeration date
06/16/2022
Last updated
06/16/2022
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