Organization
SOUTHERN IILINOIS PATHOLOGY LABORATORY LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ORDIE H KING JR. D D S PH D (LABORATORY DIRECTOR)
(618) 466-3645
Entity
Organization
Contact information
Practice address
6111 VOLLMER LN, GODFREY, IL 62035-1062
(618) 466-3645
(618) 466-3410
Mailing address
PO BOX 1166, ALTON, IL 62002-1166
(618) 466-3645
(618) 466-3410
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
02/18/2007
Last updated
01/14/2008
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