| NPI | 1114698040 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARONDA FORTE CEO 270-987-1338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2021-09-21 |
| Last Update Date | 2022-02-25 |