| NPI | 1558015933 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATASHA RENEE BURGESS Owner/Administrator 866-974-6632 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2022-02-04 |
| Last Update Date | 2022-02-04 |