| NPI | 1619481215 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ATTA Q SHAHID Owner 618-421-2247 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2017-11-20 |