Organization
CROSSROADS LABORATORY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL RUSSELL BROWN (EXECUTIVE DIRECTOR)
(801) 557-9788
Entity
Organization
Contact information
Practice address
6337 S HIGHLAND DR STE 110, SALT LAKE CITY, UT 84121-2107
(801) 557-9788
Mailing address
6337 S HIGHLAND DR STE 110, SALT LAKE CITY, UT 84121-2107
(801) 557-9788
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
46D2058259
UT
Other
Enumeration date
12/01/2015
Last updated
12/01/2015
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