| NPI | 1528436367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAULA DEANNE CROOK Past Credentialing Agent/AO 770-449-4193 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2015-09-10 |
| Last Update Date | 2021-04-01 |