| NPI | 1508089418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAFAEL CHIKVASHVILI President CEO 410-363-4301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: MD 21D1066645) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: PA 39D2043923) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2012-09-07 |