Organization
VISRAV,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRABHAV K TELLA (ADMINISTRATOR)
(972) 607-9980
Entity
Organization
Contact information
Practice address
825 W ROYAL LN, SUITE 210, IRVING, TX 75039-3601
(972) 607-9980
Mailing address
825 W ROYAL LN, SUITE 210, IRVING, TX 75039-3601
(972) 607-9980
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
45D2090337
TX
Other
Enumeration date
03/09/2015
Last updated
03/20/2015
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