Organization
MYCOBACTERIOLOGY LABORATORY
Active
Organization
MYCOBACTERIOLOGY LABORATORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILL GRAMER (BILLING MANAGER)
(617) 983-6907
Entity
Organization
Contact information
Practice address
305 SOUTH ST, BOSTON, MA 02130-3515
(617) 983-6907
(617) 983-6399
Mailing address
305 SOUTH ST, BOSTON, MA 02130-3515
(617) 983-6907
(617) 983-6399
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
NA
MA
Other
Enumeration date
01/18/2007
Last updated
08/22/2020
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