HIGH DESERT DIAGNOSTIC LABORATORY
Medical Laboratory at Division St, Prescott, AZ

License number
Arizona 03D2075971
Category
Medical Laboratory
Type
Clinical Medical Laboratory
Owner
Name: THOMAS C FELLOWS
Title: PRESIDENT
Phone: (928) 713-1290
Address
Address
1003 Division St SUITE 5, Prescott, AZ 86301
National Provider ID: 1063831121
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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HIGH DESERT DIAGNOSTIC LABORATORY, INC

1699 Laurel Ln, Prescott, AZ 86301

Registration:
Jan 28, 2014
State ID:
-1901109-0
Expiration:
PERPETUAL
President:
Brett Sovey (President), 1699 Laurel Ln, Prescott, AZ 86301 (Physical)
Agent:
Tom Fellows,1699 Laurel Ln, Prescott, AZ 86301 (Physical)

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