| NPI | 1356753107 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONYA BELETA HUNTER Director, Owner 888-879-1856 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: VA 0206009831) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: VA 49D2067382) |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2014-05-28 |