Individual
MR. BRIAN JEFFREY PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS
Contact information
Practice address
2501 SW E AVE, LAWTON, OK 73505-7320
(580) 250-1123
(580) 250-8495
Mailing address
2501 SW E AVE, LAWTON, OK 73505-7320
(580) 250-1123
(580) 250-8495
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/10/2010
Last updated
05/10/2010
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