Organization
PROGRESSIVE MEDICAL LAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAYADA AL HUSSAINI (MGR)
(386) 795-4324
Entity
Organization
Contact information
Practice address
1690 DUNLAWTON AVE, SUITE 120, PORT ORANGE, FL 32127-8979
(386) 271-2273
(386) 845-0221
Mailing address
345 BEVILLE RD, SUITE 101, SOUTH DAYTONA, FL 32119-2165
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
800027387
FL
Other
Enumeration date
10/10/2014
Last updated
10/10/2014
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