Individual
MR. BILLY BURKE STANGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MLT
Contact information
Practice address
125 DILLON DR APT 104, LANDER, WY 82520-2938
(575) 937-5752
Mailing address
125 DILLON DR APT 104, LANDER, WY 82520-2938
(575) 937-5752
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
93339
NM
Other
Enumeration date
01/15/2010
Last updated
01/15/2010
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