Organization
LIFE SPAN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MERCEDES BOATWRIGHT (ADMINISTRATIVE)
(352) 257-0575
Entity
Organization
Contact information
Practice address
265 SW LAKE FOREST WAY, PORT ST LUCIE, FL 34986-1771
(813) 477-0631
Mailing address
265 SW LAKE FOREST WAY, PORT ST LUCIE, FL 34986-1771
(813) 477-0631
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
09/29/2015
Last updated
09/29/2015
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