| NPI | 1306125612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA RUMBLE Provider Enrollment Specialist 304-293-5033 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: WV 51D2024487) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2011-08-04 |