| NPI | 1245920099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATISHA MYRIE CEO 833-294-6969 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2023-05-15 |