| NPI | 1083412290 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILY ANNALIESA FOWLER Owner 813-284-8563 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 305S00000X Point of Service |
| Enumeration Date | 2025-03-04 |
| Last Update Date | 2025-03-04 |