| NPI | 1669175998 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KANDISE S. FORD Director 870-278-8997 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 163W00000X Registered Nurse |
| Enumeration Date | 2023-03-24 |
| Last Update Date | 2023-03-24 |