Individual
TARENCE LACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4225 CARL ST, DALLAS, TX 75210-1102
(903) 401-9712
Mailing address
4225 CARL ST, DALLAS, TX 75210-1102
(903) 401-9712
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
24922916
TX
Other
Enumeration date
03/15/2023
Last updated
03/15/2023
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