| NPI | 1720739162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLESHA SMITH Lab Director 863-617-3689 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 247ZC0005X Pathology, Clinical Laboratory Director, Non-physician |
| Enumeration Date | 2022-01-18 |
| Last Update Date | 2022-01-18 |