| NPI | 1588621650 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWIN FUENTES Physician 434-791-0306 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: VA 49D0965836) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2015-11-30 |