Individual
ANSENIO CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MLT
Contact information
Practice address
1565 E TRINITY BLVD, MONTGOMERY, AL 36106-2897
(334) 440-4538
Mailing address
1565 E TRINITY BLVD, MONTGOMERY, AL 36106-2897
(334) 440-4538
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
06/10/2024
Last updated
06/10/2024
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