| NPI | 1003156688 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY STANTON Owner 954-678-0078 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: CA CLF00343433) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2013-02-19 |
| Last Update Date | 2016-10-03 |