| NPI | 1265846695 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA JACKSON President 267-566-2075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2023-05-15 |