| NPI | 1114306636 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON BOURQUE Owner 972-242-5388 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: TX 45D2095694) |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2018-06-20 |