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Organization
IMMUNOLASE LLC
Active
Organization
IMMUNOLASE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENNEN LARK (MEMBER/CEO)
(504) 372-6250
Entity
Organization
Contact information
Practice address
1901 MANHATTAN BLVD BLDG D, HARVEY, LA 70058-3583
(504) 372-6250
Mailing address
PO BOX 1414, SAGAMORE BEACH, MA 02562-1414
(504) 372-6250
Taxonomy
Speciality
Code
Description
License number
State
207KI0005X
Clinical & Laboratory Immunology (Allergy & Immunology) Physician
Primary
19D2105974
LA
Other
Enumeration date
02/09/2016
Last updated
03/23/2018
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