Organization
COMPLETE REFERENCE LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK KENT (GENERAL MANAGER)
(817) 793-5392
Entity
Organization
Contact information
Practice address
4032 N MILLER RD STE A106, SCOTTSDALE, AZ 85251-4572
(817) 793-5392
Mailing address
4032 N MILLER RD STE A106, SCOTTSDALE, AZ 85251-4572
(817) 793-5392
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
PENDING
—
Other
Enumeration date
11/30/2017
Last updated
11/30/2017
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