Organization
PROLAB SERVICSE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHANNA L LOOTENS (OWNER MANAGER)
(573) 659-5460
Entity
Organization
Contact information
Practice address
1705 CHRISTY DR STE 105, JEFFERSON CITY, MO 65101-5195
(573) 659-5460
Mailing address
1705 CHRISTY DR STE 105, JEFFERSON CITY, MO 65101-5195
(573) 659-5460
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
MO
Other
Enumeration date
04/17/2007
Last updated
08/22/2020
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