Organization
SEVENTY SEVEN HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA IACULLO (DIRECTOR)
(561) 715-9288
Entity
Organization
Contact information
Practice address
183 JOG RD, WEST PALM BEACH, FL 33415-2343
(561) 715-9288
Mailing address
183 JOG RD, WEST PALM BEACH, FL 33415-2343
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
10D2052648
FL
Other
Enumeration date
04/19/2013
Last updated
04/19/2013
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