Organization
OLLAE MEDICAL DIAGNOSTIC LABORATORY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ONESIMO FLORES (PRESIDENT)
(708) 710-1601
Entity
Organization
Contact information
Practice address
5529 W CERMAK RD, CICERO, IL 60804-2218
(708) 710-1601
Mailing address
5529 W CERMAK RD, CICERO, IL 60804-2218
(708) 710-1601
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
07/15/2011
Last updated
07/15/2011
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