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414-293-2806

Provider Lab Order Submission Form

Sign up by completing the form below.

First Name

Last Name

Email

Phone

Fax Number

Practice name

I attest that I am an authorized healthcare provider submitting a valid lab order.

I confirm this lab order is medically necessary.

Approximately how many patients do you send for lab work each month?

Thanks for submitting!

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OPENING HOURS

Monday - Saturday: 8:00am – 5:30pm Sunday: CLOSED

After-hours appointments available upon request

Tel: 414-293-2806

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