Organization
PREMIERE MEDICAL LABORATORIES P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN MARY RENDON MD (PRESIDENT)
(352) 787-6733
Entity
Organization
Contact information
Practice address
913 E NORTH BLVD, LEESBURG, FL 34748-5364
(352) 787-6733
(352) 787-9228
Mailing address
PO BOX 499100, LEESBURG, FL 34749-9100
(352) 787-6733
(352) 787-9228
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
APPLIED FOR
FL
Other
Enumeration date
02/05/2008
Last updated
12/04/2008
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