| NPI | 1629795679 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSIE WEBSTER Owner 906-202-9378 |
| Organization Subpart ? | No |
| Primary Taxonomy | 293D00000X Physiological Laboratory |
| Additional Taxonomies | 335V00000X Portable X-ray and/or Other Portable Diagnostic Imaging Supplier |
| Enumeration Date | 2022-10-20 |
| Last Update Date | 2022-10-20 |