| NPI | 1225688369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWENDOLYN MCRAE Owner 470-300-8721 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2020-01-23 |