| NPI | 1780178764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD WILSON Owner 678-561-3037 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: MD 21D2149021) |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2018-08-02 |