| NPI | 1255106555 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMMESHA MOORE Owner 478-588-7339 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246RP1900X Technician, Pathology, Phlebotomy |
| Additional Taxonomies | 171W00000X Contractor |
| 333600000X Pharmacy | |
| Enumeration Date | 2023-11-16 |
| Last Update Date | 2023-11-16 |