| NPI | 1235883943 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONTELL MARIE JOHNSON Owner 985-713-2270 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2022-02-10 |
| Last Update Date | 2022-02-25 |