| NPI | 1043936297 |
|---|---|
| Former Legal Business Name | DISTINCTIVE DIAGNOSTICS LABORATORY |
| Entity Type | Organization |
| Authorized Contact | STACI BEASLEY CEO/Owner 717-881-0575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2022-10-18 |
| Last Update Date | 2023-01-30 |