Contract Details
Ancillary Care Services
Facility name
Tomoka Medical Lab
Provider ID
P000005871
Tax ID
592962543
Effective Date
4/1/2012
Last Updated
10/2/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
209 Dunlawton Avenue Suite 19
Port Orange, FL 32129
United States
County
Volusia
Phone
3867616081 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address