| NPI | 1255473906 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERNEST ROY STUART Administrator 662-726-5831 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: MS 25D0318770) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2020-08-22 |