Organization
FLORIDA LAB SOURCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE ANTHONY CIRILLO (PRESIDENT)
(561) 309-0134
Entity
Organization
Contact information
Practice address
11350 SW VILLAGE PKWY, PORT ST LUCIE, FL 34987-2352
(561) 309-0134
Mailing address
13805 FOLKSTONE CIR, WELLINGTON, FL 33414-7704
(561) 309-0134
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
800027325
FL
Other
Enumeration date
11/30/2015
Last updated
11/30/2015
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