| NPI | 1427419977 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WADE ROSENBURG Owner 972-924-5790 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: CO 06D2108802) |
| Enumeration Date | 2016-03-11 |
| Last Update Date | 2016-03-11 |