Organization
CLEAN IMAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN HICKS MLS (PRESIDENT/LABORATORY DIRECTOR)
(413) 464-7521
Entity
Organization
Contact information
Practice address
10 WENDELL AVENUE EXT, SUITE 105, PITTSFIELD, MA 01201-6283
(413) 464-7521
(877) 208-8430
Mailing address
10 WENDELL AVENUE EXT, SUITE 105, PITTSFIELD, MA 01201-6283
(413) 464-7521
(877) 208-8430
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
22D2047480
MA
Other
Enumeration date
03/08/2013
Last updated
03/08/2013
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