Organization
CHARLEY STANLEY LABORATORIES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLOTTE BOATENG VDOVYCHENKO (LAB DIRECTOR)
(817) 915-1800
Entity
Organization
Contact information
Practice address
414 N MAIN ST, STE 214, EULESS, TX 76039-3655
(817) 915-1800
Mailing address
190 E STACY RD, STE 306-198, ALLEN, TX 75002-8734
(817) 915-1800
(682) 503-6649
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
45D2108388
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45D2108388
CLIA
TX
Enumeration date
02/22/2016
Last updated
08/05/2016
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