| NPI | 1063829711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NIKIRA BOGGS Owner 770-990-9252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 347C00000X Private Vehicle (Licence: GA L201400045) |
| 291U00000X Clinical Medical Laboratory (Licence: GA L201400045) | |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2014-11-06 |