| NPI | 1619364262 |
|---|---|
| Former Legal Business Name | TRIDENT LABS, LLC |
| Entity Type | Organization |
| Authorized Contact | NICOLE KELSEY Billing Manager 616-510-8125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2020-11-18 |