Individual
LANE STEWART PARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
413 COUNTRY CLUB DR, EDMOND, OK 73003-2736
(405) 330-7901
Mailing address
413 COUNTRY CLUB DR, EDMOND, OK 73003-2736
(405) 330-7901
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT104
OK
Other
Enumeration date
03/16/2007
Last updated
07/08/2007
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