03D2111356 CLIA NUMBER - Banner Physician Super Specialists Ari

Laboratory Demographics

CLIA Number: 03D2111356

Facility Name: Banner Physician Super Specialists Ari

Facility Address:
5310 W Thunderbird Rd Ste 310
Glendale, AZ
ZIP 85306
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Facility Phone Number: (602) 865-4470

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1578125738

Taxonomy: 133NN1002X - Nutritionist

CLIA Record

Field Name	Field Value
CLIA Number	03D2111356
LAB Type	PHYSICIAN OFFICE
Facility Name	Banner Physician Super Specialists Ari
Street	5310 W Thunderbird Rd Ste 310
City	Glendale
State	AZ
ZIP	85306
Phone	(602) 865-4470

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This page was last updated on: 4/7/2021