| NPI | 1427654219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARISSA MARIE HOLTON Provider Enrollment 712-279-1839 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2020-12-08 |
| Last Update Date | 2020-12-08 |