| NPI | 1649690280 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA M JOHNSON Owner/Operator 800-641-6130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246RP1900X Technician, Pathology, Phlebotomy (Licence: IL D4B3A5A9) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2014-04-22 |