04D2076501 CLIA NUMBER - ADVANCED ALLERGY AND ASTHMA DR. MELISSA GRAHAM AND ASSOCIATES

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Laboratory Demographics

CLIA Number: 04D2076501

Facility Name: ADVANCED ALLERGY AND ASTHMA DR. MELISSA GRAHAM AND ASSOCIATES

Facility Address:
500 SOUTH UNIVERSITY, S-215
LITTLE ROCK, AR
ZIP 72205
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Facility Phone Number: 501 420-1085

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1619219433

Taxonomy: 261QP3300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	04D2076501
LAB Type	Physician Office
Facility Name	ADVANCED ALLERGY AND ASTHMA DR. MELISSA GRAHAM AND ASSOCIATES
Street	500 SOUTH UNIVERSITY, S-215
City	LITTLE ROCK
State	AR
ZIP	72205
Phone	501 420-1085
CertificateType	4
CertificateEffectiveDate	4/22/2024
CertificateExpirationDate	4/21/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024