| NPI | 1417618380 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAYA GARLAND Director 708-925-7672 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2022-01-04 |
| Last Update Date | 2022-01-11 |