Organization
LONGEVITY LABORATORY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY NELSON MIXON MD (MEDICAL DIRECTOR)
(425) 605-8715
Entity
Organization
Contact information
Practice address
9757 NE JUANITA DR, 202, KIRKLAND, WA 98034-4299
(425) 605-8715
(425) 654-0211
Mailing address
9757 NE JUANITA DR, 202, KIRKLAND, WA 98034-4299
(425) 605-8715
(425) 654-0211
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
08/13/2012
Last updated
08/13/2012
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