| NPI | 1457320194 |
|---|---|
| Doing Business As | NONE |
| Entity Type | Organization |
| Authorized Contact | RUSSELL H WONG Medical Director Md 813-641-0484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: FL 800001365) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: FL 800001365) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2012-01-26 |