| NPI | 1093138760 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEAN EDWARD WILLIS Director 904-791-1559 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: FL DI003429) |
| Enumeration Date | 2014-01-30 |
| Last Update Date | 2014-01-30 |