| NPI | 1194714709 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSEANNE MARIE AMADO Administrator 783-960-0372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: PR 332) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: PR 40D0667079) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2020-08-22 |