Individual
MR. LYRIC JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3513 PLANO VISTA NE, RIO RANCHO, NM 87124
(505) 433-7039
Mailing address
3513 PLANO VISTA RD NE, RIO RANCHO, NM 87124-4183
(505) 433-7039
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
107737260
NM
Other
Enumeration date
04/30/2013
Last updated
04/30/2013
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