| NPI | 1417948969 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA K WILSON Owner 620-515-0619 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: KS 17D1046361) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2008-01-22 |