| NPI | 1164962882 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA LEBERTE Credentialing Manager 309-322-8931 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: GA 11D2125186) |
| Enumeration Date | 2017-02-28 |
| Last Update Date | 2026-02-24 |