Organization
PGN LAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CORY BRANDON HANLON (OWNER)
(561) 818-8054
Entity
Organization
Contact information
Practice address
7847 SW ELLIPSE WAY, STUART, FL 34997-7247
(561) 818-8054
Mailing address
4365 HICKORY DR, PALM BEACH GARDENS, FL 33418-3905
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
FL
Other
Enumeration date
11/01/2017
Last updated
11/01/2017
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