10D0289271 CLIA NUMBER - DWIC OF TAMPA BAY INC

Laboratory Demographics

CLIA Number: 10D0289271

Facility Name: DWIC OF TAMPA BAY INC

Facility Address:
408 E BRANDON BLVD
BRANDON, FL
ZIP 33511
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Facility Phone Number: (813) 681-5571

Facility Type: OTHER PRACTITIONER

Certificate Type: Waiver

NPI Number: 1417906611

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0289271
LAB Type	OTHER PRACTITIONER
Facility Name	DWIC OF TAMPA BAY INC
Street	408 E BRANDON BLVD
City	BRANDON
State	FL
ZIP	33511
Phone	(813) 681-5571

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This page was last updated on: 5/11/2023