Individual
MRS. LISA JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
124 S BROADWAY AVE STE 200, ADA, OK 74820-5825
(580) 332-3001
Mailing address
16017 COUNTY ROAD 3535, ADA, OK 74820-0850
(580) 272-3217
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
12/14/2010
Last updated
09/24/2014
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