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General NPI Number Information
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NPI Number | 1144765082
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Entity Type | Organization
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Legal Business Name | VALENCE TOXICOLOGY LAB LP
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Dates
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Enumeration Date | 01/02/2017
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Last Update Date | 01/02/2017
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Provider Practice Location Address
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Address Line | 5908 STONE CREEK DR SUITE 130 C
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City | LEWISVILLE
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State | TX
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Zip | 75056-2637
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Country | US
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Telephone | 305-230-4191
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Fax |
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Provider Business Mailing Address
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Address Line | 5908 STONE CREEK DR SUITE 130 C
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City | LEWISVILLE
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State | TX
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Zip | 75056-2637
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Country | US
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Telephone | 305-230-4191
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JUSTIN HARDIN
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Credential | MD
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Telephone | 305-230-4191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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