| NPI | 1013003458 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARRELL N FISKE Medical Director 772-286-9779 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: FL JR36022300) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2020-08-22 |