Organization
BLACK WATER LAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN FLUITT (OFFICE MANAGER)
(318) 410-9900
Entity
Organization
Contact information
Practice address
4150 OLD STERLINGTON RD STE C, MONROE, LA 71203-2670
(318) 410-9900
Mailing address
4150 OLD STERLINGTON RD STE C, MONROE, LA 71203-2670
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
02/08/2019
Last updated
02/22/2019
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