| NPI | 1609528447 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYNAYA N GRAY Owner 773-354-3386 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse |
| Enumeration Date | 2022-01-24 |
| Last Update Date | 2022-02-23 |