| NPI | 1396985636 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AYAZ M SAMADANI Owner 920-887-7731 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2009-02-26 |
| Last Update Date | 2014-07-14 |