Organization
PREMIERTOX, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN WALTERS (PRESIDENT)
(270) 866-3144
Entity
Organization
Contact information
Practice address
2431 LAKEWAY DRIVE, SUITE A1, RUSSELL SPRINGS, KY 42642
(270) 866-3144
Mailing address
PO BOX 1240, RUSSELL SPRINGS, KY 42642-1240
(270) 866-3144
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
10/14/2010
Last updated
10/27/2010
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