Individual
MR. CORY BLAINE PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
3410 TAFT BLVD, WICHITA FALLS, TX 76308-2036
(940) 397-4824
(940) 397-4901
Mailing address
6018 VAN DORN DR, WICHITA FALLS, TX 76310-2829
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT1804
TX
Other
Enumeration date
05/16/2007
Last updated
07/08/2007
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