Individual
MR. ADAM COY LACKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSFA, CST
Contact information
Practice address
2115 VERMILLION OAK ST, FRESNO, TX 77545-2063
(713) 410-4042
Mailing address
2115 VERMILLION OAK ST, FRESNO, TX 77545-2063
(713) 410-4042
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
—
—
Other
Enumeration date
07/13/2013
Last updated
07/13/2013
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