Organization
GULFSTREAM GENOMICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEAN VISKOVICH ESQ. (VICE PRESIDENT OF LEGAL)
(972) 630-6443
Entity
Organization
Contact information
Practice address
9301 N CENTRAL EXPY, STE 335, DALLAS, TX 75231-0806
(972) 640-6400
Mailing address
9301 N CENTRAL EXPY, STE 335, DALLAS, TX 75231-0806
(972) 640-6400
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
45D2096977
TX
Other
Enumeration date
04/21/2016
Last updated
09/19/2017
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