| NPI | 1023540465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY BEALL Owner/President 225-445-5814 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: LA 19D0991695) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2017-04-03 |