Organization
PROFESSIONAL CLINICAL LABORATORY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN E STAGER MS (MANAGER)
(262) 542-8020
Entity
Organization
Contact information
Practice address
1111 DELAFIELD ST, SUITE 309, WAUKESHA, WI 53188-3417
(262) 542-8020
(262) 542-4312
Mailing address
1111 DELAFIELD ST, SUITE 301, WAUKESHA, WI 53188-3417
(262) 542-8020
(262) 650-4398
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
52D1062818
WI
Other
Enumeration date
02/12/2009
Last updated
02/12/2009
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