Organization
REVIVED MEDICAL LAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAVANDA MARTIN RN (DIRECTOR)
(843) 799-2649
Entity
Organization
Contact information
Practice address
2724 W PALMETTO ST STE 5, FLORENCE, SC 29501-4909
(843) 799-2649
(843) 799-4224
Mailing address
2724 W PALMETTO ST STE 5, FLORENCE, SC 29501-4909
(843) 799-2649
(843) 799-4224
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
08/30/2021
Last updated
10/11/2021
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