10D2082314 CLIA NUMBER - ELITE DNA THERAPY SERVICES LLC

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Laboratory Demographics

CLIA Number: 10D2082314

Facility Name: ELITE DNA THERAPY SERVICES LLC

Facility Address:
4310 METRO PARKWAY SUITE 205
FORT MYERS, FL
ZIP 33966
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Facility Phone Number: (239) 223-2751

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1508231416

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2082314
LAB Type	PHYSICIAN OFFICE
Facility Name	ELITE DNA THERAPY SERVICES LLC
Street	4310 METRO PARKWAY SUITE 205
City	FORT MYERS
State	FL
ZIP	33966
Phone	(239) 223-2751

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