Organization
AG SCREENING LAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LOMETRIA WILSON (OWNER)
(843) 616-8770
Entity
Organization
Contact information
Practice address
108A E MAIN ST, LATTA, SC 29565-1617
(843) 418-1197
(843) 418-1097
Mailing address
108A E MAIN ST, LATTA, SC 29565-1617
(843) 418-1197
(843) 418-1097
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42D2257730
—
SC
Enumeration date
05/10/2022
Last updated
05/10/2022
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