Organization
BRADSHAW MOUNTAIN DIAGNOSTIC LABORATORY INC
Active
Parent organization
BRADSHAW MOUNTAIN DIAGNOSTIC LABORATORY INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BRADSHAW MOUNTAIN DIAGNOSTIC LABORATORY INC
Authorized official
MR. TOM FELLOWS (PRESIDENT)
(928) 778-7823
Entity
Organization
Contact information
Practice address
579 W WICKENBURG WAY, #8, WICKENBURG, AZ 85390-4300
(928) 684-0332
(928) 684-0537
Mailing address
990 WILLOW CREEK RD, PRESCOTT, AZ 86301-1640
(928) 778-7823
(928) 778-9419
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
08/13/2008
Last updated
08/13/2008
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