| NPI | 1720042021 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTIE R STAUSS Physician Services Manager 629-255-2620 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: TN 3305) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2017-10-12 |