Bradshaw Mountain Diagnostic Laboratory INC
NPI #1508012253 in Wickenburg, Arizona
Provider Information
- NPI Number
- 1508012253
- Entity Type
- Organization
- Organization Name
- Bradshaw Mountain Diagnostic Laboratory INC
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- BRADSHAW MOUNTAIN DIAGNOSTIC LABORATORY INC
- Primary Specialty
- Clinical Medical Laboratory
- Enumeration Date
- Aug 13, 2008
- Last Updated
- Aug 13, 2008
Practice Location
- Address
- 579 W WICKENBURG WAY
- Address 2
- #8
- City
- Wickenburg
- State
- Arizona
- ZIP Code
- 85390-4300
- Phone
- (928) 684-0332
Authorized Official
- Name
- MR. TOM FELLOWS
- Title
- PRESIDENT
- Phone
- (928) 778-7823
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinical Medical Laboratory |
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