Contract Details
Facility name
One Source Toxicology, Inc
Provider ID
P000004114
NPI
1245409457
Tax ID
760608760
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1213 Genoa Red Bluff Rd
Pasadena, TX 77504
United States
County
Harris
Phone
7139202559 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address