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: E Date Issued: 05/31/11 Amarillo Lab PO Box 3200 College Station TX 77841 College Station TX 77843 Amarillo TX 79116 Amarillo TX 79106 Ph: 979-845-3414 Accession # 6610 Amarillo Blvd West Ph: 806-353-7478 Ph: 888-646-5623 Fax: 979-845-1794 Ph: 888-646-5624 Fax: 806-359-0636 *** Information Below REQUIRED *** Owner Research Agreement # ACCOUNT/ID # Address Assignments Clinic Opened By Address City City State Carrier State Zip Zip E-Mail Phone # Phone # Fax # Date S.

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