Organization
ESOTERIX GENETIC LABORATORIES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY T WILLIAMS (VP)
(800) 222-7566
Entity
Organization
Contact information
Practice address
17772 17TH ST, SUITE 200 ROOM 217, TUSTIN, CA 92780-1944
(800) 710-1800
Mailing address
PO BOX 2240, BURLINGTON, NC 27216-2240
(800) 222-7566
(336) 436-1048
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0642715
CLIA
—
Enumeration date
11/16/2010
Last updated
06/24/2016
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