Organization
AZ LAB, LLC
Active
Other names
Corebella Allergy & Diagnostics
Organization subpart
No
Provider details
NPI number
Authorized official
JONNA ELAINE DEMORE (OWNER)
(623) 242-0346
Entity
Organization
Contact information
Practice address
2210 S MILL AVE, 8, TEMPE, AZ 85282-2153
(623) 242-0346
Mailing address
2210 S MILL AVE, 8, TEMPE, AZ 85282-2153
(623) 242-0346
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
4476
AZ
207Q00000X
Family Medicine Physician
4476
AZ
208D00000X
General Practice Physician
4476
AZ
Other
Enumeration date
02/17/2016
Last updated
02/17/2016
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