| NPI | 1134617004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY CALLEAN MCKENZIE Director Of Administration 772-380-5742 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2018-08-24 |