Organization
ANDREA BALCONIS
Active
Other names
Gulfport Testing
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA BALCONIS (OWNER)
(228) 383-2147
Entity
Organization
Contact information
Practice address
200 PASS RD, SUITE 3, GULFPORT, MS 39507-3033
(228) 383-2147
(601) 510-2611
Mailing address
200 PASS RD, SUITE 3, GULFPORT, MS 39507-3033
(228) 383-2147
(601) 510-2611
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
25D1086897
MS
Other
Enumeration date
07/25/2008
Last updated
07/25/2008
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