| NPI | 1164188678 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY LEWIS Owner 904-489-6974 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 246RP1900X Technician, Pathology Phlebotomy |
| Enumeration Date | 2021-11-10 |
| Last Update Date | 2023-02-08 |