| NPI | 1316309800 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNATHAN LIVINGSTON WAGNER Owner 386-463-4444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 293D00000X Physiological Laboratory |
| Additional Taxonomies | 2471C3402X Radiologic Technologist, Radiography |
| 2471M1202X Radiologic Technologist, Magnetic Resonance Imaging | |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2017-05-31 |