Individual
LANCE GHOLSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
301 W WARRIOR TRL, GRAND PRAIRIE, TX 75052-5718
(972) 343-1676
(972) 343-1515
Mailing address
301 W WARRIOR TRL, GRAND PRAIRIE, TX 75052-5718
(972) 343-1676
(972) 343-1515
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT4061
TX
Other
Enumeration date
07/30/2019
Last updated
07/30/2019
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