| NPI | 1164448296 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CEDRIC PRANGE Administrator 912-355-6615 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: GA 00000) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2020-08-22 |