| NPI | 1215115142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA KAY LONNEMAN Office Manager 228-762-9531 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MS 80030) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2008-02-01 |
| Last Update Date | 2022-07-21 |