| NPI | 1255087201 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY DOVE PITTMAN CEO 317-701-4191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2022-03-01 |
| Last Update Date | 2022-03-01 |