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Organization
PATHOLOGY SERVICES LABORATORY PA
Active
Organization
PATHOLOGY SERVICES LABORATORY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHRISTINA A JETTON MD (PRESIDENT)
(479) 968-6781
Entity
Organization
Contact information
Practice address
1430 WEST C STREET, RUSSELLVILLE, AR 72801
(479) 968-6781
(479) 968-3074
Mailing address
PO BOX 925, RUSSELLVILLE, AR 72811
(479) 968-6781
(479) 968-3074
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
NULL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Enumeration date
03/22/2006
Last updated
05/31/2024
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