| NPI | 1790407005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KALETHIA BUSH Director 972-861-2013 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246RM2200X Technician, Pathology Medical Laboratory |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2022-09-13 |
| Last Update Date | 2023-02-13 |