Organization
GRACE HEALTHCARE LABORATORY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID WOLF (PRESIDENT)
(228) 863-3331
Entity
Organization
Contact information
Practice address
1120 BROAD AVE, GULFPORT, MS 39501-2414
(228) 863-3331
(228) 863-3392
Mailing address
1120 BROAD AVE, GULFPORT, MS 39501-2414
(228) 863-3331
(228) 863-3392
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09752571
—
MS
Enumeration date
07/13/2005
Last updated
12/31/2007
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