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General NPI Number Information
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NPI Number | 1932868106
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Entity Type | Organization
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Legal Business Name | SISTERS OF LOVE LAB SERVICES
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Dates
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Enumeration Date | 12/14/2021
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 826 UNION BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63108-1040
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Country | US
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Telephone | 314-399-5496
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Fax |
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Provider Business Mailing Address
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Address Line | 5532 PAGE BLVD # 2F
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City | SAINT LOUIS
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State | MO
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Zip | 63112-4124
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Country | US
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Telephone | 314-399-5496
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SIERRA BRUTON
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Credential |
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Telephone | 314-399-5496
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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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