| NPI | 1104546415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHONDA LAWANDA WILLIS Owner 314-614-2991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 247ZC0005X Pathology Clinical Laboratory Director, Non-physician |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2022-08-29 |