Organization
MAT-SU MEDICAL LABORATORY, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAULINE BULLARD (OWNER)
(907) 376-1122
Entity
Organization
Contact information
Practice address
224 N YENLO ST STE 3B, WASILLA, AK 99654-7195
(907) 376-1122
Mailing address
224 N YENLO ST STE 3B, WASILLA, AK 99654-7195
(907) 376-1122
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
AK
Other
Enumeration date
09/18/2012
Last updated
07/21/2022
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